Facial presentations of migraine, TACs, and other paroxysmal facial pain syndromes

TY - JOUR

T1 - Facial presentations of migraine, TACs, and other paroxysmal facial pain syndromes

AU - Ziegeler, Christian

AU - May, Arne

N1 - © 2019 American Academy of Neurology.

PY - 2019/9/17

Y1 - 2019/9/17

N2 - 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 In addition, we present 6 patients who reported a constant side-locked facial pain with superseded well-defined facial pain attacks of 10- to 30-minute duration that appeared several times per day.CONCLUSION: Our data suggest that a facial involvement in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.

AB - 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.

KW - Adult

KW - Diagnosis, Differential

KW - Facial Neuralgia/diagnosis

KW - Facial Pain/diagnosis

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Migraine Disorders/diagnosis

KW - Retrospective Studies

KW - Tertiary Care Centers/trends

KW - Trigeminal Autonomic Cephalalgias/diagnosis

U2 - 10.1212/WNL.0000000000008124

DO - 10.1212/WNL.0000000000008124

M3 - SCORING: Journal article

C2 - 31434691

VL - 93

SP - e1138-e1147

JO - NEUROLOGY

JF - NEUROLOGY

SN - 0028-3878

IS - 12

ER -