WHAT IS CRANIO-FACIAL PAIN?
Cranio-facial pain is a group of pain syndromes that affect, to a greater or a lesser extent, the head and face. The pain may be dull and throbbing or an intense, stabbing discomfort in one side or in both sides of the face or forehead. The pain may be caused by a nervous disorder, an injury or an infection in a structure of the face; but it may also have originated in neighbouring areas.
- Trigeminal Neuralgia
- Glossopharyngeal neuralgia
- Greater occipital nerve neuralgia (known as Arnold’s neuralgia)
- Postherpetic Neuralgia which is especially annoying when it affects the Ist branch (i.e. the face and eye)
- Intermediate nerve neuralgia
- Temporomandibular joint syndrome
- Horton’s vascular headache or cluster headache
- Cancer (usually by invasion of the cranial nerves)
- Carotidynia (pain in the carotid artery)
- Dental origin, e.g. dental abscess
- Arteritis of the temporal artery
- Cranio-facial trauma
- Post-surgical origin, especially after extensive cranio-facial surgery
Sometimes cranio-facial pain occurs for unknown reasons; but in any case it is essential to distinguish between the different types of cranio-facial pain to avoid unsuccessful treatments.
HOW IS DIAGNOSIS MADE?
Though diagnosis is still based solely on medical history and symptomatolgy, modern imaging techniques, especially high-resolution MRI images, provide critical information to study the possible causes of these syndromes.
The first treatment for any pain syndrome is pharmacological. First, an attempt will be made at eliminating the cause of pain. If this is not possible, or if the pain persists even after eliminating the cause, specific drugs will be administered depending on the type of pain. Nociceptive pain responds well to anti-inflammatories and opiates, but neuropathic pain requires anti-epileptic drugs (AEDs) and AED derivatives.
If the pain does not respond to drug therapy, or if the result is insufficient, surgical treatment may be considered. Depending on the cause of pain, different techniques will be applied to stimulate the damaged nerve using electric currents, administer opioids directly into the brain, or to interrupt the pain transmission pathways (e.g. (for example the DREZ lesion of the caudalis nucleus of the trigeminus or RF spheno-palatine ganglion). However, a thorough assessment of the risks and benefits is required. It should be remembered that, in general, the treatment of pain is a ladder where each rung climbed increases the effectiveness but also the chance of complications and severe side effects.