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This page is the second of two, to provide a broad overview of syndromes and disorders that may produce face or head pain. Local referral links are provided for WPAHS care providers who treat these disorders. World-wide information resources are offered to help you understand how each disorder is diagnosed, managed and treated. Please be aware as you read, that the symptoms of some of these problems overlap. Determining which problem or problems are affecting a particular patient, is a task for a professionally licensed, highly trained care provider. A special note: if you
are having a sudden experience of pain in your face as you read this article,
then please take a personal inventory of other sensations in your body.
If you also have radiating pain in your upper back, chest, or arms, or
if you are perspiring heavily, then please contact an emergency care center
immediately. This combination of symptoms is sometimes a sign of
heart attack.
To move quickly to information on a named disorder, please select a link from the list below.
Muscle Contraction Headache As indicated in an Intellihealth introduction to headache, "An estimated 45 million Americans experience chronic headaches. For at least half of these people, the problem is severe and sometimes disabling... Not all headaches require medical attention. Some result from missed meals or occasional muscle tension and are easily remedied. But some types of headache are signals of more serious disorders, and call for prompt medical care." Of particular concern is any headache which is sudden and severe, associated with convulsions, confusion, or loss of consciousness. A physician should be seen for such complaints, as well as for headache following a blow to the head, associated with pain in the eye or ear, or associated with fever. Muscle-contraction headaches -- also called "tension headaches" -- "can last for weeks, months, and sometimes years. The pain of these headaches is often described as a tight band around the head or a feeling that the head and neck are in a cast... The pain is steady, and is usually felt on both sides of the head. Chronic muscle-contraction headaches can cause sore scalps--even combing one's hair can be painful... For many people, chronic muscle-contraction headaches are caused by depression and anxiety. A strained posture or reading in poor light may also contribute to such pain. "Treatment for muscle-contraction headache varies. The first consideration is to treat any specific disorder or disease that may be causing the headache...Acute tension headaches not associated with a disease are treated with muscle relaxants and analgesics like aspirin and acetaminophen. Stronger analgesics, such as propoxyphene and codeine, are sometimes prescribed" under close medical supervision. Reference:
Intellihealth
WPAHS Caregivers:
(select 'headache' from left side menu). Dr. Peter Jannetta, M.D.Return to Table of Contents "Like fibromyalgia, myofascial pain dysfunction syndrome (MPDS) is a painful condition of the skeletal muscles. Many people suffer with both fibromyalgia and myofascial pain dysfunction syndrome (termed, FMS/MPS Complex) at the same time. More women than men have FMS, but MPDS affects men and women in equal numbers. Usually, when we refer to MPDS, we are referring to the muscles of mastication as well as the neck and shoulder muscles, though other skeletal muscles may also be affected. However, the muscles of mastication and the neck and shoulder muscles seem to be most commonly involved. Some researchers believe that MPDS may be a minor or localized type of fibromyalgia. "MPDS is characterized by the development of trigger points. A trigger point or sensitive, painful area in the muscle or the junction of the muscle and fascia (hence, myofascial pain) develops due to any number of causes. This trigger point is locally tender and when active, refers pain through specific patterns to distant areas..." [abridged
with permission from
Management of MPDS may involve medication
with muscle relaxants or non- steroidal anti-inflammatory drugs, stress
management, regulation of diet and exercise, elimination of caffiene, and
biofeedback. Recognizing that the disorder is not "all in the patient's
head," stress management may be supported by appropriate counseling and
life style changes. Multi-disciplinary approaches to this complex disorder
appear to have definite benefits over single-mode treatment. It is
particularly important that patients be moniored for advancing signs of
depression.
Cindy Fleishman, Face Pain Resources] WPAHS Caregivers: Dr. Peter Jannetta, M.D.Return to Table of Contents "Geniculate Ganglion or Nervus Intermedius Neuralgia is an uncommon condition resulting in deep ear pain with or without signs of atypical trigeminal neuralgia, deep face, or throat pain." Microvascular decompression neurosurgery has provided sustained relief for a substantial proportion of pain patients with this confirmed diagnosis, without the use of nerve section or its associated side effects. WPAHS Caregivers:Dr. Peter Jannetta, M.D.Return to Table of Contents "Occipital Neuralgia is characterized by pain located in the cervical (neck) and posterior (back) regions of the head. In some patients, pain may extend or radiate into the sides of the head to the facial and frontal regions. Occipital neuralgia is really two separate disorders with similar symptoms: lesser occipital nerve neuralgia and greater occipital neuralgia. "This disorder often occurs after a whiplash injury, a blow to the back of the head, or an injury that produces a twisting of the head. The symptoms include pain originating in the neck or the back of the head, and radiating forward toward the face. Differential diagnosis is possible using anesthetic blocks. "Occipital neuralgia is often misdiagnosed as Fibrocytis or Fibromyalgia or worse, cervical spine arthritis or a disc problem. It also commonly occurs with TMJ, often magnifying the pain in the face and temples that is primarily caused by TMJ. Occipital Neuralgia, even though considered a neuralgia, cannot be classified as a TN or ATN problem." Compression of a different nerve is involved. However, occipital neuralgia can be successfully treated by microvascular decompression in many cases. [abridged
with permission from
WPAHS Caregivers:
Cindy Fleishman, Face Pain Resources] Original Reference: Dr. Wesley Shakland, D.D.S, Ph.D. Dr. Peter Jannetta, M.D. Post Herpetic Neuralgia is a pain condition which appears to result from flare-ups of a virus that may lie dormant in the body for many years after a patient has experienced the skin rash associated with shingles. The rash is called herpes zoster, and it may occur in a number of areas of the body. Post herpetic neuralgia, however, is more severe and long lasting (sometimes months to years) pain caused by nerve damage specifically in the trigeminal nerve in the face. Thus far, no generally reliable treatment for this disorder has been developed. However, some patients have had success in moderating the pain by applications of Capsasin cream, containing an extract of the active ingredient in red peppers. Work is also underway to evaluate effectiveness of lidocaine patches. WPAHS Caregivers:Dr. John Brillman "Temporal tendinitis has been called "The Migraine Mimic" because so many symptoms are similar to migraine headache pain. Symptoms include: TMJ pain, ear pain and pressure, temporal headaches, cheek pain, tooth sensitivity, neck and shoulder pain. Treatment consists of injecting local anesthetics and other medications, a soft diet, using moist heat, muscle relaxants and anti-inflammatory medications, and physiotherapy. Only rarely (in approximately 4% of cases) is surgery needed." Used with
Permission:
Return
to Table of Contents
Dr. Wesley Shankland, D.D.S., Ph.D. Temporo Mandibular Joint Disorder (TMJ) TMJ is a disorder of the joint of the jaw which can cause a wide range of face and throat pain symptoms. TMJ is one of the many causes of chronic headaches. In some cases, it may be accompanied by popping or clicking sounds in the joint, difficulty in opening and closing the mouth, pain in the jaw joint or ear, or even visual disturbances [Reference ]. Treatment may include reversible or "passive" means (lifestyle changes, intraoral splint, medications to relax facial muscles), or invasive means (adjusting the bite, orthodontic treatment, surgery of several types). Since a number of problems other than TMJ can mimic this disorder, accurate diagnosis is essential. Likewise, the rate of recovery for TMJ patients may be affected by appropriate recognition and treatment of depresson often associated with chronic pain [see, for instance, Dr. Wesley Shankland, D.D.S., Ph.D] This site offers a detailed overview of Trigeminal Neuralgia diagnosis, treatment, and world wide resources. Chronic sinusitis is a long lasting inflammation of the sinus cavities beneath the cheeks and forehead. Symptoms include deep pain in the area of the cheek and forehead, running or drippy nose. It has been estimated that over 30 million Americans have this medical problem. [Reference] This disorder is often associated with asthma or allergies. [Reference] When inflammation is severe and long lasting, it may be mistaken for other face pain disorders, including trigeminal neuralgia. Likewise, the reverse is also true: neurologic disorders like TN can be mistaken for sinusitis. Common treatments for sinusitis are ineffective for neurologic disorders. Specifically, antibiotics that have historically been prescribed for sinusitis have proven ineffective for both sinusitis and TN. For many patients, bacterial infection may not be the cause of the observed medical problem. Reference Note: Many
of the links above were researched by Cindy Fleishman, who is herself a
chronic pain patient and educator. Additional information is available
at Face Pain Resources,
the site she created and co-edits. All links have been reviewed for
general content. Naturally, however, WPAHS cannot accept responsibility
for the accuracy of information offered by other sites. See Disclaimers.
DISCLAIMER:Every effort has been made by the author(s) to provide accurate, up-to-date information. However, the medical knowledge base is dynamic and errors can occur. By using the information contained herein, the viewer willingly assumes all risks in connection with such use. Neither the author nor WPAHS shall be held responsible for errors, omissions in information herein nor liable for any special, consequential, or exemplary damages resulting, in whole or in part, from any viewer(s)' use of or reliance upon, this material. CLINICAL DISCLAIMER:Clinical information is provided for educational purposes and not as a medical or professional service. Person(s) who are not medical professionals should have clinical information reviewed and interpreted or applied only by the appropriate health professional(s). |
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Site Index Frequently Asked Questions on Healthcare Face Pain Overview * Trigeminal Neuralgia * Hemifacial Spasm * Meniere's Disease * Vertigo * Tinitis * Hypertension * Torticalis and Spasmodic Torticalis For questions or comments, please contact: aghneuro@wpahs.org * Department of Neurosurgery * Allegheny General Hospital * 320 East North Ave. * Pittsburgh, PA 15212 * (412) 359-6200 * Toll Free: 877-284-2000 © 2000 West Penn Allegheny
Health System
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