Dr. Saad Al Asiri FACIAL PAIN & HEADACHE MD, DLO, KSF, Rhino General Secretary Assistant for Training & Program Accreditation ENT Consultant and Rhinologist

FACIAL PAIN AND HEADACHE Facial pain & headache is confusing issue to patient & doctor. "Classification of causes of facial pain" - sinus pain - odontogenic pain

- orbital pain - neural pain *primary neuralgia (V trigeminal neuralgia - IX nerve glessopharyngeal neuralgia ) * Sluder neuralgia *secondary neuralgia 5/22/2018

a typical TMJ dysfunction Facial pain vascular pain Migraine Cluster Temporal arteries muscle and joint pain Muscle contraction, headache a typical TMJ dysfunction Facial pain

Detail History is essential to reach proper diagnosis PATIENT EVALUTAION Detail History is essential to reach proper diagnosis Headache & facial pain Character Location Onset

Aggravating & relieving factors Past history Duration Frequency Aggravating & relieving factors Past history Past history of medication Smoking and alcohol intake 5/22/2018

Proper & full ENT examination Proper & full ophthalmology examination Proper & full neurology examination maxillo facial surgery At the end psychology examination

Paranasal Sinus Pain The character headache site in relation to sinus Easy in acute more than CH sinusitis Symptoms signs of sinusitis Post ethmoid & sphenoid → vision symptoms as well  R/O granulomatous lesion Benign & malignant lesion C.T. + MRI Endoscopy + Biopsy

Odontogenic Pain Orbital Pain GP, dentist + facial maxillary surgeon R/O TMJ dysfunction Orbital Pain Eye strain "refractory errors muscle inflame" Intraocular inflammation e.g. Glaucoma Disease of external eye All refers to ophthalmologist

Trigeminal Neuralgia The commonest neuralgia Chronic recurring paroxysmal pain of brief duration The cause aberrant vessel lying on V ganglion Pain starting nose & spread into face & head Trigger, chewing, talking, shaving, cold wind exposure Ipsilateral lacrimation, rhinorrhea, facial redness Pain is usual unilateral Rx medical and surgical

The Glossopharyngeal Neuralgia Same quality of pain as V neuralgia But occure around ear & tonsils Swallowing, taking, eating trigger the pain Surgery of the nerve Through tonsillectomy as access to the nerve Post Herpetic neuralgia may last for months after vesicles subsided

C.N. & Lesion Multiple sclerosis Tumor Fracture of skull bones Sluder's Neuralgia Anterior ethmoidal syndrome Location of pain Causes Rx Cervical Neuralgia Neck injury

Vacular Pain Migraine Recurrent attacks of headache Unilateral onset Associated with nausea & vomiting It may proceeded by neuralgia and mood disturbance Strong family history Duration: one hour → few hours Throbbing in character

Cluster Headache Less common than migraine Middle age man Common in smoker, alcoholic Unilateral temporal, frontal Boring, stabbing, non throbbing Ipsilateral lacrimation & rhinorrhea Attacks occurs in cluster every 4-6 seconds

Temporal Arteritis Giant cell arteritis Elderly Temporal headache Ischemia of head & neck organs Associated with myalgia neck, shoulder, back

Headache aggravated by local pressure Biopsy 50% Headache aggravated by local pressure Worse complication e.g. Blindness Examination tends, nodular, temporary arteries which may pulseless ↑ ESR 5/22/2018

Muscle contraction headache T. M. Joint dysfunction Character of headache Proper history & examination Role of Radiology Refer to facial maxillary surgeon

A Typical facial pain The diagnosis is made after exclude all organic cause Pain lasting 6/12 Non anatomical distribution F:M 10:1 e.g. > 40 years Reffer to psychiatry

5/22/2018