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Abstract
Objective To assess the prevalence of facial pain (V2 and/or V3) presentations among nearly 3,000 patients with headache treated in a university tertiary care center.
Methods Between 2010 and 2018, we routinely assessed the prevalence of facial pain presentations of all patients with primary headaches.
Results Of 2,912 patient datasets, 291 patients reported facial pain either as an independent or as an additional symptom. Among patients with migraine, 2.3% (44 of 1,935) reported a facial involvement, most commonly in V2. Of these, 18 patients (40.9%) experienced the pain predominantly in the face. In patients with cluster headache, 14.8% (42 of 283) reported a facial involvement, of which 31.0% perceived the pain predominantly in the face. A facial involvement was seen in 45.0% of patients with paroxysmal hemicrania (9 of 20), 21.4% of patients with hemicrania continua (9 of 42), and 20.0% of patients with short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing/short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (3 of 15). In addition, we present 6 patients who reported a constant side-locked facial pain with superseded well-defined facial pain attacks of 10- to 30-minute duration that appeared several times per day.
Conclusion Our data suggest that a facial involvement in primary headaches is infrequent but not uncommon. A sole facial presentation of primary headache symptomatology seems to be exceptionally rare. We describe 3 different types of facial pain involvement and, in this context, distinguish patients with paroxysmal orofacial pain syndromes that have not been previously described. These patients may represent a new entity that could tentatively be called constant unilateral facial pain with added attacks.
Glossary
- CUFPA=
- constant unilateral facial pain with added attacks;
- ICDH-3=
- International Classification of Headache Disorders, 3rd edition;
- ICOP=
- International Classification of Orofacial Pain;
- HC=
- hemicrania continua;
- IHS=
- International Headache Society;
- PIFP=
- persistent idiopathic facial pain;
- PH=
- paroxysmal hemicrania;
- SUNA=
- short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms;
- SUNCT=
- short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing;
- TAC=
- trigeminal autonomic cephalalgia;
- TN=
- trigeminal neuralgia
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
CME Course: NPub.org/cmelist
- Received November 19, 2018.
- Accepted in final form April 24, 2019.
- © 2019 American Academy of Neurology
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- Author response: Facial presentations of migraine, TACs, and other paroxysmal facial pain syndromes
- Reader response: Facial presentations of migraine, TACs, and other paroxysmal facial pain syndromes
- Reader response: Facial presentations of migraine, TACs, and other paroxysmal facial pain syndromes
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