Facial pain shows discomfort or pain localized to the face. Headaches are the most common neurological disorder to cause pain in the head or upper neck.
The trigeminal nerve and its branches supply somatosensory innervation to head and face.
The trigeminal nerve originates in the pons and divides into three divisions including ophthalmic (V-1), maxillary (V-2), mandibular (V-3).
The trigeminal system provides sensory innervation to cranial coverings and vessels while seventh, ninth, and tenth cranial nerves have trigeminal pain connections.
Mucoceles may cause pain when they exert pressure on sinus bony walls. Frontoethmoidal mucocele causes significant frontal headache and orbital pain.
Nasal cavity mucosal contact points may cause rhinogenic facial pain. Cluster headache features severe unilateral temporal pain in grouped attacks lasting minutes to hours.
Severe pain in the somatosensory branch of the seventh cranial nerve occurs in the external auditory canal.
Epidemiology
Trigeminal Neuralgia (TN) occurs in 12 per 100,000 people. TN affects individuals >50 years of age.
Atypical Facial Pain occurs in about 0.03–1% of the population. It is common in middle-aged women.
Postherpetic neuralgia develops in 10–20% of individuals with shingles.
Headache affects about 50% of adults worldwide per year. Chronic daily headache presents in 4–5% of the population.
Cluster Headache occurs in about 0.1% of the population. It affects individuals between 20 to 40 years of age.
Anatomy
Pathophysiology
Viral damage to neurons leads to constant burning pain through sensitization. Chronic pain potentially linked to central sensitization and cortical processing.
Facial or cervical trigger points cause referred pain through hyperirritable muscle fibres.
Sinus mucosa inflammation activates nociceptive pathways in trigeminal nerve branches.
Cortical Spreading Depression causes neuronal depolarization results in aura and nociception activation.
Chronic facial pain and headaches involve central sensitization, where repeated stimulation lowers the CNS pain threshold.
Etiology
The causes of facial pain and headache are:
Musculoskeletal causes
Inflammatory and Infectious causes
Neuropathic causes
Vascular causes
Primary Headaches and secondary Headaches
Cranial Neuralgias and Nerve Involvement
Genetics
Prognostic Factors
Multiple sclerosis, tumors, untreated pain, central sensitization, and comorbid depression or anxiety worsen nerve damage and treatment outcomes.
The prognosis of facial pain and headache relies on underlying cause, diagnosis timing, treatment effectiveness, and patient-specific factors.
Prognosis for facial pain and headache depends on cause, duration, treatment response, and various influential factors.
Clinical History
Collect details including aggravating, relieving factors, family and medical history to understand clinical history of patient.
Physical Examination
Head and Scalp Examination
Face Examination
Neck Examination
Neurological Examination
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Acute symptoms are:
Neck stiffness, acute Angle-Closure Glaucoma, severe unilateral headache with eye pain, blurry vision
Chronic symptoms are:
Recurrent, mild to moderate dull headache, chronic facial pain associated with jaw dysfunction or chewing
Differential Diagnoses
Migraine
Trigeminal Neuralgia
Subarachnoid Hemorrhage
Sinusitis
Myofascial Pain Syndrome
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Consultations should align with clinical suspicion of facial pain and headache causes.
Consult an otolaryngologist for head, neck lesions, or sinus headaches.
Neurologist evaluation is necessary for primary headache syndrome or cranial neuralgia.
Dentists and oral surgeons should manage patients with dental or craniomandibular pain causes.
Evaluate intracranial hemorrhage or meningitis in emergency cases.
Facial pain shows discomfort or pain localized to the face. Headaches are the most common neurological disorder to cause pain in the head or upper neck.
The trigeminal nerve and its branches supply somatosensory innervation to head and face.
The trigeminal nerve originates in the pons and divides into three divisions including ophthalmic (V-1), maxillary (V-2), mandibular (V-3).
The trigeminal system provides sensory innervation to cranial coverings and vessels while seventh, ninth, and tenth cranial nerves have trigeminal pain connections.
Mucoceles may cause pain when they exert pressure on sinus bony walls. Frontoethmoidal mucocele causes significant frontal headache and orbital pain.
Nasal cavity mucosal contact points may cause rhinogenic facial pain. Cluster headache features severe unilateral temporal pain in grouped attacks lasting minutes to hours.
Severe pain in the somatosensory branch of the seventh cranial nerve occurs in the external auditory canal.
Trigeminal Neuralgia (TN) occurs in 12 per 100,000 people. TN affects individuals >50 years of age.
Atypical Facial Pain occurs in about 0.03–1% of the population. It is common in middle-aged women.
Postherpetic neuralgia develops in 10–20% of individuals with shingles.
Headache affects about 50% of adults worldwide per year. Chronic daily headache presents in 4–5% of the population.
Cluster Headache occurs in about 0.1% of the population. It affects individuals between 20 to 40 years of age.
Viral damage to neurons leads to constant burning pain through sensitization. Chronic pain potentially linked to central sensitization and cortical processing.
Facial or cervical trigger points cause referred pain through hyperirritable muscle fibres.
Sinus mucosa inflammation activates nociceptive pathways in trigeminal nerve branches.
Cortical Spreading Depression causes neuronal depolarization results in aura and nociception activation.
Chronic facial pain and headaches involve central sensitization, where repeated stimulation lowers the CNS pain threshold.
The causes of facial pain and headache are:
Musculoskeletal causes
Inflammatory and Infectious causes
Neuropathic causes
Vascular causes
Primary Headaches and secondary Headaches
Cranial Neuralgias and Nerve Involvement
Multiple sclerosis, tumors, untreated pain, central sensitization, and comorbid depression or anxiety worsen nerve damage and treatment outcomes.
The prognosis of facial pain and headache relies on underlying cause, diagnosis timing, treatment effectiveness, and patient-specific factors.
Prognosis for facial pain and headache depends on cause, duration, treatment response, and various influential factors.
Collect details including aggravating, relieving factors, family and medical history to understand clinical history of patient.
Head and Scalp Examination
Face Examination
Neck Examination
Neurological Examination
Acute symptoms are:
Neck stiffness, acute Angle-Closure Glaucoma, severe unilateral headache with eye pain, blurry vision
Chronic symptoms are:
Recurrent, mild to moderate dull headache, chronic facial pain associated with jaw dysfunction or chewing
Migraine
Trigeminal Neuralgia
Subarachnoid Hemorrhage
Sinusitis
Myofascial Pain Syndrome
Consultations should align with clinical suspicion of facial pain and headache causes.
Consult an otolaryngologist for head, neck lesions, or sinus headaches.
Neurologist evaluation is necessary for primary headache syndrome or cranial neuralgia.
Dentists and oral surgeons should manage patients with dental or craniomandibular pain causes.
Evaluate intracranial hemorrhage or meningitis in emergency cases.
Otolaryngology
Plastic Surgery and Anesthetic Medicine
Increase the use soft lighting in spaces where patient spends long period of time.
Explore more in natural light but avoid direct sun during peak hours to prevent headaches.
Reduce screen time or use filters to reduce glare. Position computer monitors at eye level and comfortable distance.
Establish soothing sounds to minimize loud disruptions. Utilize fans or air conditioners in summer and heaters in winter for comfort.
Proper awareness about facial pain and headache should be provided and its related causes with management strategies.
Appointments with physician and preventing recurrence of disorder is an ongoing life-long effort.
Otolaryngology
Plastic Surgery and Anesthetic Medicine
Ibuprofen:
It inhibits synthesis of prostaglandins in body tissues with 2 COX isoenzymes.
Otolaryngology
Plastic Surgery and Anesthetic Medicine
Sumatriptan:
It is a selective 5-HT1 receptor agonist used to reduce inflammation of neuronal nerve.
Otolaryngology
Plastic Surgery and Anesthetic Medicine
Propranolol:
It is a nonselective beta-adrenergic receptor blocker that decreases heart rate.
Otolaryngology
Plastic Surgery and Anesthetic Medicine
Nortriptyline:
It increases concentration of neurotransmitters in the central nervous system.
Otolaryngology
Plastic Surgery and Anesthetic Medicine
Non-contrast CT scanning of sinuses in axial and coronal sections is the standard procedure for diagnosing sinusitis.
MRI effectively evaluates internal derangement of TMJ disorders.
MRI and MR angiography (MRA) assess brain pathology and headache vascular sources effectively.
Otolaryngology
Plastic Surgery and Anesthetic Medicine
In acute phase focus on rapid symptom relief, to assess and address the underlying cause, and prevent worsening of symptoms.
Pharmacologic therapy is effective in the treatment phase as it includes the use of NSAIDs, triptans, beta blocker, and antidepressants.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and interventional therapies.
The regular follow-up visits with the physician are scheduled to check the improvement of patients along with treatment response.
Facial pain shows discomfort or pain localized to the face. Headaches are the most common neurological disorder to cause pain in the head or upper neck.
The trigeminal nerve and its branches supply somatosensory innervation to head and face.
The trigeminal nerve originates in the pons and divides into three divisions including ophthalmic (V-1), maxillary (V-2), mandibular (V-3).
The trigeminal system provides sensory innervation to cranial coverings and vessels while seventh, ninth, and tenth cranial nerves have trigeminal pain connections.
Mucoceles may cause pain when they exert pressure on sinus bony walls. Frontoethmoidal mucocele causes significant frontal headache and orbital pain.
Nasal cavity mucosal contact points may cause rhinogenic facial pain. Cluster headache features severe unilateral temporal pain in grouped attacks lasting minutes to hours.
Severe pain in the somatosensory branch of the seventh cranial nerve occurs in the external auditory canal.
Trigeminal Neuralgia (TN) occurs in 12 per 100,000 people. TN affects individuals >50 years of age.
Atypical Facial Pain occurs in about 0.03–1% of the population. It is common in middle-aged women.
Postherpetic neuralgia develops in 10–20% of individuals with shingles.
Headache affects about 50% of adults worldwide per year. Chronic daily headache presents in 4–5% of the population.
Cluster Headache occurs in about 0.1% of the population. It affects individuals between 20 to 40 years of age.
Viral damage to neurons leads to constant burning pain through sensitization. Chronic pain potentially linked to central sensitization and cortical processing.
Facial or cervical trigger points cause referred pain through hyperirritable muscle fibres.
Sinus mucosa inflammation activates nociceptive pathways in trigeminal nerve branches.
Cortical Spreading Depression causes neuronal depolarization results in aura and nociception activation.
Chronic facial pain and headaches involve central sensitization, where repeated stimulation lowers the CNS pain threshold.
The causes of facial pain and headache are:
Musculoskeletal causes
Inflammatory and Infectious causes
Neuropathic causes
Vascular causes
Primary Headaches and secondary Headaches
Cranial Neuralgias and Nerve Involvement
Multiple sclerosis, tumors, untreated pain, central sensitization, and comorbid depression or anxiety worsen nerve damage and treatment outcomes.
The prognosis of facial pain and headache relies on underlying cause, diagnosis timing, treatment effectiveness, and patient-specific factors.
Prognosis for facial pain and headache depends on cause, duration, treatment response, and various influential factors.
Collect details including aggravating, relieving factors, family and medical history to understand clinical history of patient.
Head and Scalp Examination
Face Examination
Neck Examination
Neurological Examination
Acute symptoms are:
Neck stiffness, acute Angle-Closure Glaucoma, severe unilateral headache with eye pain, blurry vision
Chronic symptoms are:
Recurrent, mild to moderate dull headache, chronic facial pain associated with jaw dysfunction or chewing
Migraine
Trigeminal Neuralgia
Subarachnoid Hemorrhage
Sinusitis
Myofascial Pain Syndrome
Consultations should align with clinical suspicion of facial pain and headache causes.
Consult an otolaryngologist for head, neck lesions, or sinus headaches.
Neurologist evaluation is necessary for primary headache syndrome or cranial neuralgia.
Dentists and oral surgeons should manage patients with dental or craniomandibular pain causes.
Evaluate intracranial hemorrhage or meningitis in emergency cases.
Otolaryngology
Plastic Surgery and Anesthetic Medicine
Increase the use soft lighting in spaces where patient spends long period of time.
Explore more in natural light but avoid direct sun during peak hours to prevent headaches.
Reduce screen time or use filters to reduce glare. Position computer monitors at eye level and comfortable distance.
Establish soothing sounds to minimize loud disruptions. Utilize fans or air conditioners in summer and heaters in winter for comfort.
Proper awareness about facial pain and headache should be provided and its related causes with management strategies.
Appointments with physician and preventing recurrence of disorder is an ongoing life-long effort.
Otolaryngology
Plastic Surgery and Anesthetic Medicine
Ibuprofen:
It inhibits synthesis of prostaglandins in body tissues with 2 COX isoenzymes.
Otolaryngology
Plastic Surgery and Anesthetic Medicine
Sumatriptan:
It is a selective 5-HT1 receptor agonist used to reduce inflammation of neuronal nerve.
Otolaryngology
Plastic Surgery and Anesthetic Medicine
Propranolol:
It is a nonselective beta-adrenergic receptor blocker that decreases heart rate.
Otolaryngology
Plastic Surgery and Anesthetic Medicine
Nortriptyline:
It increases concentration of neurotransmitters in the central nervous system.
Otolaryngology
Plastic Surgery and Anesthetic Medicine
Non-contrast CT scanning of sinuses in axial and coronal sections is the standard procedure for diagnosing sinusitis.
MRI effectively evaluates internal derangement of TMJ disorders.
MRI and MR angiography (MRA) assess brain pathology and headache vascular sources effectively.
Otolaryngology
Plastic Surgery and Anesthetic Medicine
In acute phase focus on rapid symptom relief, to assess and address the underlying cause, and prevent worsening of symptoms.
Pharmacologic therapy is effective in the treatment phase as it includes the use of NSAIDs, triptans, beta blocker, and antidepressants.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and interventional therapies.
The regular follow-up visits with the physician are scheduled to check the improvement of patients along with treatment response.
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