Facial Pain, Headache,

and Otalgia
Khristine T. Girado - Pizarro, MD, FPSO-HNS
 Major Categories
1. Vascular headache of migraine type

2. Muscle - contraction headache

3. Combined Headache: Vascular + Muscle-contraction

4. Headache of Nasal Vasomotor Reaction

5. Headache of delusional, conversion, or hypochondriacal

states
 Major Categories
6. Nonmigrainous Vascular Headaches

7. Traction Headache

8. Headache due to overt cranial inflammation

9 - 13. Headache due to disease of ocular, aural, nasal and

sinus, dental, or other cranial or neck structures

14. cranial neuritides

15. cranial neuralgias

 Vascular Headache of
Migraine Type
A. “classic” migraine

B. “common” migraine

C. “cluster” headache

D. “hemiplegic” and “ophthalmoplegic” migraine

E. “lower half” headache

 “classic” migraine

• sharply defined, transient visual and other sensory or

motor prodromes or both
 “common” migraine

• without striking prodromes

• also known as “sick headache” or atypical migraine

• “menstrual” or “pre-menstrual” headache, “summer”,

“Monday”
 “cluster” headache
• predominantly unilateral facial and head pain occurs primarily in
men

• sudden onset and abrupt cessation

• most excruciating vascular headache

• no prodrome; 1 to 3 attacks/day; 45 mins to 1 hour, occurs in

clusters during a period of up to 3 months

• focus of pain is usually entered behind one eye, with radiation to

involve the entire side of the face and neck

• flushing, sweating, rhinorrhea, and increased lacrimation

 “cluster” headache
• mechanism: dilatation of extracranial and dural arteries

• treatment:

1. 100% oxygen inhalation

2. Ergotamine inhalation - most effective

3. lidocaine nose drops

4. Methysergide - prophylaxis; Propranolol - preventive

5. during attacks - ergotamine, methysergide, corticosteroids, lithium

carbonate, Ca channel blocker

6. psychotherapy
 Muscle-Contraction
Headache

• chronic in nature

• ache or sensations of tightness, pressure or constriction;

“hat band”

• frontal, temporal, occipital and sub occipital regions

• tension, psychogenic and nervous headaches

 Headache of Nasal
Vasomotor Reaction
• Nasal obstruction, with or without rhinorrhea, tightness or
burning

• recurrent and resulting from congestion and edema of nasal

and paranasal mucus membrane

• not proven to be due to allergens, infectious agents or local

gross anatomic defects

• predominantly anterior in location and mild to moderate in

intensity

• “vasomotor rhinitis”
 Sinusitis

• Maxillary - anterior facial with radiation into teeth, orbital

and malar region

• Ethmoids - interocular with spread into frontal location

• Frontal - forehead, interocular, and temporal areas

• Sphenoid - retro-orbital, radiation towards vertex and

occasionally mastoid areas
Causes of Otalgia
Causes of Otalgia
Evaluation of Headache
• Age of patient at onset

• Duration of problem

• Duration single attacks

• Frequency of attacks

• more frequent occurrence at a certain time of day

• onset following trauma or development of another

medical problem
Evaluation of Headache
1. prodromal or associated symptoms (if any)

2. location

3. quality

4. precipitating factors

5. factors intensifying pain

6. response to medication

7. recent or previous dental work

8. psychosocial history
 Clinical Examination
• auscultation for bruit

• eye examination

• evaluation of CN function

• palpation for arterial tenderness

• palpation for muscle spasm and tenderness

• evaluation for nuchal rigidity

• complete ORL examination including evaluation of occlusion

• palpation of TMJ
 Diagnostics
• PNS, Skull, dental, cervical spine, TMJ radiographs

• Head CT Scan

• Head MRI

• Lumbar puncture

• EEG

• Personality profile

• Thermography

minnesota multiphase personality inventory