Classification of persistent idiopathic facial pain according to ICHD-3. A. Facial pain and/or pain in the oral region that meets criteria B and C. B. Recurrent for at least two hours/day for more than three months. C. The pain has both of the following characteristics: Difficult to localize and does not follow the supply area … Facial Pain: Classification
The medical history (history of the patient) represents an important component in the diagnosis of facial pain. Family history What is the general health of your family members? Are there any diseases in your family that are common? Social history What is your profession? Current medical history/systemic history (somatic and psychological complaints). Are you experiencing … Facial Pain: Medical History
Respiratory System (J00-J99) Rhinosinusitis (simultaneous inflammation of the nasal mucosa (“rhinitis”) and the mucosa of the paranasal sinuses). Sinusitis maxillaris/frontalis – sinusitis of the maxillary sinus / frontal sinus. Eyes and eye appendages (H00-H59). Acute inflammation of the eye, unspecified. Acute glaucoma (green star) Iritis (inflammation of the iris) Optic neuritis (neuritis nervi optici; optic … Facial Pain: Or something else? Differential Diagnosis
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; further: Inspection (viewing). Skin and mucous membranes Head Eyes Ophthalmological examination – including tonometry (measurement of intraocular pressure) – if diseases of the eyes are suspected. ENT medical examination including epipharyngoscopy (nasopharyngoscopy) … Facial Pain: Examination
2nd order laboratory parameters – depending on the results of the history, physical examination and obligatory laboratory parameters – for differential diagnostic clarification. Small blood count Differential blood count Inflammatory parameters – CRP (C-reactive protein) or ESR (erythrocyte sedimentation rate). Infectious serology – if infections are suspected. Temporal artery biopsy – for suspected temporal arteritis.
Therapy target Pain relief Therapy recommendations Therapy trial with: Duloxetine, venlafaxine (noradrenergic and specific serotonergic antidepressants) (NaSSA)). Amitriptyline (tricyclic antidepressants ) Carbamazepine, gabapentin, topiramate (anticonvulsants/drugs for the treatment of seizure disorders). Combination of anticonvulsants with antidepressants is possible. See also under “Further therapy.”
Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics, and obligatory medical device diagnostics – for differential diagnostic clarification. X-rays of the paranasal sinuses, temporomandibular joint – in the case of chronic sinusitis (sinusitis) or tumor. X-ray examination of the face (occipitodental image to show the maxillary sinus/maxillary … Facial Pain: Diagnostic Tests
The following symptoms and complaints may indicate facial pain or atypical facial pain: Symptoms of typical facial pain Electrifying pain Short duration Symptoms of atypical facial pain (= persistent idiopathic facial pain). Dull, pressing pain coming from the depths. Persistent, i.e. present daily Predominantly continuous, unilateral and poorly localizable Often in the area of the … Facial Pain: Symptoms, Complaints, Signs
Pathogenesis (development of disease) Facial pain can have multiple causes (see Differential diagnoses below). Persistent idiopathic facial pain (IHS 13184) must meet the following criteria: A. Facial pain that meets criteria B and C is present daily and for most of the day. B. Initially, facial pain is confined to a circumscribed region of one … Facial Pain: Causes
General measures Avoidance of long stays in the cold (due toaggravation of pain by exposure to cold). Physical therapy (including physiotherapy) Myofunctional therapy (MFT; synonym: orofacial muscle function therapy) – supportive form of therapy in orthodontics; exercises of the orofacial musculature are intended to retrain chewing, tongue, lip, and cheek muscles, thereby ideally causing or … Facial Pain: Therapy
