Facial Paindiagnostic Approach

The Migraine And Headache Program

Migraines Alternative Treatments

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Pain in the face may result from many different disorders and often presents as a diagnostic problem to the neurologist or neurosurgeon. Consider:

1. Site of pain

Postherpetic neuralgia usually 1st trigeminal division

Atypical facial pain diffuse

Trigeminal neuralgia 1st, 2nd ,3rd c trigeminal divisions

Dental around mouth

2. Quality of pain

Trigeminal neuralgia

Atypical facial pain

Postherpetic neuralgia

Dental

Sinusitis

Ocular

Costen's syndrome Cluster headache f Sinusitis frontal or maxillary

Cluster headache ^ above/behind the eye

(glaucoma) behind the eye

~ Costen's syndrome in front of and behind the ear

' Tolosa Hunt syndrome orbital and frontal

- sharp, stabbing, shooting, paroxysmal

- dull, persisting

- dull, burning, persisting, occasional paroxysm

- sharp, boring, worse in the morning

- dull, throbbing

- severe aching, aggravated by chewing

- sharp, intermittent

3. Associated symptoms/signs

Trigeminal neuralgia

Atypical facial pain Postherpetic neuralgia Dental Sinusitis

Ocular

Costen's syndrome Cluster headache

Investigations

- guided by clinical suspicion often no neurological deficit, but occasional blunting of pinprick over involved region accompanying features of depressive illness evidence of scarring associated with sensory loss swelling of lips/face puffy appearance around eyes, tenderness to percussion over involved sinus glaucoma: associated visual symptoms - blurring/haloes/ loss tenderness over temporomandibular joint associated lacrimation rhinorrhoea

Blood tests: ESR, FBC, biochemistry.

Imaging: CT/MRI, dental X-rays, isotope bone scan.

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