FACIAL PAIN

Mohammad Nasrullah Professor of Neurology KEMU

PAIN ROUTES
Trigeminal Nerve Sphenopalatine branch of the Facial Nerve IX & X Nerve Cervical 1, 2, 3 root

CAUSES
Neuralgias.

(Neurological)
Trigeminal Neuralgia Post Herpes zoster Neuralgia. Glasopharyngeal Neuralgia Occipital Neuralgia. Migraine variants Temporal arteritis. Atypical Facial Pain Carotidynia, Otalgia Rare Causes

Vascular.

Psychogenic
Other

Common Non Neurological Causes

SINUSES TEETH T.M. Joint ENT Diseases Cervical Diseases

Trigeminal Neuralgia
Neuralgic Pain  In distribution of V Nerve (UNILATERAL)  Spontaneous Remission & Relapses.  Trigger Points.  Normal Examination. (1-5 % Secondary) (1Test; Response to Carbamazepin.


Glassopharyngeal Neuralgia
Neuralgic pain  In Throat, ear or both  Precipitated by Swallowing. ( talking, chewing, yawning)  May lead to bradicardia, Syncope.


Post Herpes Zoster Neuralgia.

 H/O

Vesicular eruption  First division of V Nerve (most commonly effected)

Occipital Neuralgia.
 Occipital

sub occipital or post parietal area  Neuralgic Nature & Response to carbamazepin.

TREATMENT OF NEURALGIA
DRUGS Sodium chennel blockers AEDs Tegral, Phenytoin, Gabapantin Tricyclic antideprassant and Phenothiazine Baclofen

TREATMENT OF NEURALGIA
SURGICAL Blocking the nerve Microvascular decompression Removing the cause, if any.

Migraine Variants
At time pain can be on the face  Charachterist episodic pain which is Throbing with Nausea & vomiting  Responds to Ergotamine


Temporal Arteritis
Age >50 years. Mostly >60 years  Pain severe, Persistent Unilateral, usually Temporal area  Temporal Artery tender and hard.  Systemic features.  Raised ESR, Ultrasound, Temporal artery biopsy.


ATYPICAL FACIAL PAIN

All Facial exam. is Normal  Persistent unilateral facial pain, atypical in natures, no response to analgesic


PSYCHOGENIC Responds to antidepressant REQUIRES CLOSE OBSERVATION & FOLLOWUP

CAROTIDYNIA
CervicoCervico-facial pain that is elicited by pressure on the common carotid arteries Tumor or Aneurysm  Temporal Arteritis  Migrainous type  Primary


OTALGIA
Pain in/around ONE EAR Causes  Neuralgia VII, IX, X, C 1-2 1 Nasopharynqeal tumor vertebral artery Aneurysm  Primary - Cluster Headache - Migraine

RARE CAUSES
Reflex Sympathetic Dystrophy of face  Neck Tongue syndrome  Burning mouth syndrome


TAKE HOME MASSAGE

Termenologies are multiple, causes diverse and topic confusing.  Rule out Primary cause  If no cause, classify the Pain Neuralgic Vascular Psychogenic Organic