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

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

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

4. 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

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

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

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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

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

16. 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

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

18. 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

19. 5/22/2018