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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pain is a major public health problem. The management of orofacial pain may be a difficult challenge to the medical and dental professions. Ideally, severe cases of this type of pain should be treated by a team drawn from several disciplines such as neurology, otolaryngology, dentistry and psychiatry. Trigeminal neuralgia patients develop brief, very severe unilateral pain, usually radiating from the upper or lower jaw toward the ear, and confined to the distribution of the trigeminal nerve. The pain may be triggered by chewing, shaving or exposure to cold wind. Most patients respond to carbamazepine, with phenytoin or baclofen as an alternative. Intractable pain may require surgical treatment. Horton's syndrome (cluster headache) is always unilateral and is often associated with unilateral lacrimation and rhinorrhoea. The pain is extreme, and its typical localisation the eye, forehead, temple, jaws, or teeth. Treatment with ergotamine and sumatriptan has been used with some success, calcium blockers (e.g., verapamil) being used as prophylaxis. Atypical facial pain is a continuous ache with intermittent episodes, localised to non-muscular, non-joint facial areas. The pain may be unilateral or bilateral, and may persist for many years. Typically, these patients consult a variety of specialists, such as dentists and otolaryngologists. Surgical procedures such as tooth extraction or sinus surgery, even if skillfully executed, exacerbate the condition, are are thus contraindicated. If the patient does not respond to reassurance, antidepressants may be tried. In sinusitis, the pain location is dependent upon which paranasal sinus is affected. Routine diagnostic nasal endoscopy and coronal plane computed tomography enable subtle pathological changes that are related to chronic pain to be identified. If medical treatment fails to afford relief, surgery should be considered. Pain, limited range of jaw motion, and joint noises are the common characteristics of temporomandibular disorders. Treatment usually consists of non-surgical means such as splints, occlusal equilibration, and non-steroidal anti-inflammatory drugs. Surgical treatment is indicated in a few carefully selected cases. Most dental pain is attributable to caries or periodontal disease. When pus is present, drainage affords excellent pain relief. Acute pericoronitis involving mandibular third molars responds to irrigation, removal of maxillary third molar trauma, and--in cases of serious infection--antimicrobial therapy. Early recognition of a case of chronic pain improves the chances of successful management, and avoids frustration and disillusion both to patient and doctor.
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PMID:[Neurologist, otolaryngologist...? Which specialist should treat facial pain?]. 963 Jul 98

The purpose was to describe the distribution of diagnoses among all referrals to a clinic specialized in temporomandibular disorders (TMD). A series of 1500 consecutive patients, evaluated by 1 dentist, were diagnosed according to the criteria of The International Classification of Diseases, 9th Revision, Clinical Modification: ICD-9-CM. Some referrals (12%) were never evaluated, were symptom-free, or were forwarded to other clinics. Various dental, neurogenic, occlusal, dentofacial, and other problems occurred. Vague orofacial pain was common, as was tension-type headache (6% each). More than 5% of the patients were affected by systemic disorders with manifestations in the temporomandibular joints. About half of all referrals could be strictly diagnosed with TMD. Myalgia was diagnosed as the main complaint in 19%. Internal derangement 'clicking' (15%) and 'closed lock' (6%) were more common than traumatic/ unspecified arthritis (6%) or osteoarthrosis (5%). A combination of myalgia and clicking appears to be the core sign in patients referred with TMD.
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PMID:Diagnoses among referrals to a Swedish clinic specialized in temporomandibular disorders. 968 22

The styloid process and associated structures have been implicated in a variety of craniomandibular dysfunctions and pain complaints. There have been anecdotal reports that treatment directed at this area can result in a dramatic reduction in referred symptoms, somatic pain and autonomic signs as well as an increase in mandibular range of motion. In the past, an elongation of the styloid process was considered necessary for pain and dysfunction symptoms to arise from this area. The patients in this study did not have elongated styloid processes, yet had orofacial pain and dysfunction symptoms seemingly referred from this area. An injection of local anaesthetic and corticosteroid in the area of the styloid process significantly reduced lateral head pain and improved mandibular function in spite of an absence of any demonstrable pathology at the styloid process.
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PMID:The involvement of the styloid process in head and neck pain--a preliminary study. 1079 87

We present 3 patients who had episodes of orofacial pain compatible with cluster headache, the differential diagnosis being established with pulp pain of dental origin. Cocaine inhalation triggered pain in the premolar zone of the upper jaw, followed by spread of pain to the periorbital region on the same side. The pain episodes were very intense and lasted between 30 and 120 minutes. The patients presented conjunctival injection and lacrimation of the affected eye during these episodes. The crises were always unilateral. In one patient, pain shifted sides from one crisis to another within the same symptomatic or cluster period, affecting the side through which the drug was inhaled. Pain usually appeared 1 to 2 hours after cocaine consumption, though it disappeared 5 to 10 minutes after again inhaling the drug. None of our patients acknowledged cocaine consumption at the first visit; drug inhalation was only admitted at subsequent visits, once a degree of confidence had been established with the physician.
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PMID:Cluster headache and cocaine use. 1098 45

After an extensive review of the dental literature, few articles were found related to pain and implantology. Management of orofacial pain has traditionally been a difficult challenge for the dental-medical profession. Patients may be afraid of dental pain, particularly in cases of dental implantology. Therefore, a study to obtain more conclusive data was developed. Taking into account that the perception of pain and the threshold of pain vary among individuals, a 2-year clinical study was established in private practice utilizing a verbal method (double-blind). The study was used to quantify sensory and affective aspects of pain associated with dental implantology on 75 patients in a private dental office. All of the implants were placed by the same clinician. Data were recorded following a Pain Data Sheet designed for this particular study. The aim of this study was to obtain different aspects of data as follows: 1) Fear of the dentist and fear of dental implant procedures utilizing a descriptive scale of 1 to 10, with 1 indicative of no fear. 2) Dental areas and ridges: Dental pain, pain in edentulous areas, and pain in the implanted area utilizing a scale of 0 to 8, with 0 indicative of no pain. 3) Function and pain: during mastication, swallowing, speech, yawning, opening, closing, and lateral excursions and indication of cervical pain or back pain, each calibrated by the presence or absence of pain. 4) Palpation and pain of the temporomandibular joint, the temporal muscle, the area of the pterygoid muscles, masseter muscle, and sternocleidomastoid muscle, all calibrated on the indication of presence or absence of pain. 5) Others: ear pain, neuralgia, headaches, edema, and hematoma, calibrated on the basis of presence or absence. The aforementioned factors were evaluated immediately before surgery and after surgery, at 24 hours, and during a follow up for a period of 2 years at intervals of 1 week; 1, 2, 3, 4, and 6 months; and 1 and 2 years after surgery. Also recorded were the uses of presurgical and postsurgical medication at the first and second surgical phases, age, sex, buccal opening, number and position of implants, previous dental experiences, and the psychological preparation for dental implant treatment. The results of the statistical analysis indicate no correlation between pain and dental implantology procedures, in a private dental practice, at the level of significance of P > .001.
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PMID:Pain and dental implantology: sensory quantification and affective aspects. Part I: At the private dental office. 1130 42

Although many people suffer from orofacial pain and headache, objective methods for investigation of trigeminal nociception in humans have been lacking. Trigeminal brainstem reflexes such as the masseter inhibitory reflex and the blink reflex are mediated by central multireceptive neurons that are also involved in trigeminal nociception. Therefore, these trigeminal reflexes are suitable models for probing pontine and medullary pain processing.
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PMID:Brain Stem Reflexes: Probing Human Trigeminal Nociception. 1139 Aug 86

This is a case report of a male patient who presented with orofacial pain for a year as the only manifestation of syringobulbia-syringomyelia associated with Arnold-Chiari malformation. This article places emphasis on the clinical presentation and possible differential diagnoses. The pain was continuous and affected the left side of the face. It was exacerbated by coughing and physical effort, possibly as a consequence of an increase in intracranial pressure. Paroxysmal pain crises developed over this background of continuous pain, compatible with neurogenic trigeminal pain of the left second branch, together with pain episodes similar to cluster headache on the same side. The symptoms were resolved following neurosurgical management with amplification of the foramen magnum.
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PMID:Orofacial pain as the sole manifestation of syringobulbia-syringomyelia associated with Arnold-Chiari malformation. 1144 28

Primary vascular-type craniofacial pain comprises a group of pain disorders that share common diagnostic features. These are unilateral, episodic, pulsatile, severe pain. Accompanying phenomena include local autonomic (e.g., tearing, rhinorrhea) and systemic signs (e.g., nausea, photophobia). Primary vascular-type craniofacial pain includes migraine, cluster headache, and paroxysmal hemicrania. A new diagnostic entity, vascular orofacial pain, is suggested. Treatment of primary vascular-type craniofacial pain depends on its more specific diagnosis, and may be abortive or prophylactic. Diagnostic features, common pathophysiological mechanisms, and treatment modalities are discussed.
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PMID:Primary vascular-type craniofacial pain. 1191 Oct 64

Chronic paroxysmal hemicrania (CPH) is a rare type of headache that is characterized by daily, multiple, short-lasting attacks of severe pain and associated autonomic symptoms. The pain is strictly unilateral and presents most commonly in the ocular, temporal, maxillary, and frontal areas. The excruciating, throbbing pain of CPH can be misdiagnosed as pain associated with dental pathology, especially when located in the maxillary area. Moreover, pain manifesting in the maxillary and temporal areas can be confused with temporomandibular disorders. CPH patients occasionally seek treatment in dental offices or orofacial pain centers. Accordingly, dentists should be familiar with CPH in order to avoid unnecessary, irreversible dental treatment. A case is presented to highlight many of the features of CPH.
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PMID:Chronic paroxysmal hemicrania: a case report and review of the literature. 1275 34

This clinical report describes the diagnosis and treatment of a patient under emotional stress with orofacial pain, headaches, and the feeling of a foreign body in the throat. An elongated styloid process at the beginning of the oral pharynx was diagnosed. Although these symptoms could be aspects of Eagle's syndrome, deflective occlusal interferences, tender muscles of mastication, and a clicking temporomandibular joint led to an evaluation for temporomandibular disorder related to malocclusion. An occlusal splint was used to confirm the diagnosis and to alleviate symptoms. Occlusal adjustments were subsequently performed. In a 10-year follow-up, the patient had no complaints.
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PMID:Temporomandibular disorder or Eagle's syndrome? A clinical report. 1456 84


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