Atypical facial pain
| Classification according to ICD-10 | |
|---|---|
| G50.1 | Atypical facial pain |
| ICD-10 online (WHO version 2019) | |
The atypical facial pain , and persistent idiopathic facial pain called, is a diagnosis of exclusion, which was introduced in the 1920s to a distinctive way between the trigeminal neuralgia and to have other forms of pain on his face skull area. It is a pain that is continuously present, has a dull, oppressive character and usually occurs on one side.
Epidemiology
- Women are more often affected than men
- Frequency peak: middle age
- Affected people often find a depressive mood , a tendency to somatization , obsession and anxiety .
Symptoms
According to the criteria of the International Headache Society (IHS, classification 1988), the following criteria are required for diagnosis:
- no organic lesion detectable
- Daily pain that is present for most of the day
- Pain is localized on one side in a circumscribed area
- dull, oppressive character
- no sensory disturbances or other neurological deficits present
- Apparative examinations of the facial area are normal
The pain can change sides or occur on both sides as the disease progresses. It is a constant pain that is very often localized in the area of the upper jaw, the eyes, the nose and the forehead. Those affected are mostly spared at night, which means that the pain does not disturb sleep. By definition, shooting pain and trigger points (as in trigeminal neuralgia ) cannot be present.
Pathogenesis
The pathogenesis is unclear, not least because various pain syndromes are gathered behind this diagnosis. The following hypotheses exist on pathogenesis:
- psychogenic cause (Lascelles et al., 1996; Feinmann et al., 1984)
- Injury to terminal nerves after multiple extensive operations in the ENT and maxillofacial area.
- After local surgical interventions, atypical odontalgia can develop, in which a pathomechanism corresponding to phantom pain is suspected (Türp et al., 2001).
- Atypical facial pain as part of a generalized pain syndrome.
Differential diagnosis
All other causes of facial pain syndrome must be ruled out. Atypical facial pain is (only) a diagnosis of exclusion.
therapy
No recommendations can be made that are based on high evidence . The following knowledge about optimal therapy reflects the current state of affairs:
- Surgical interventions can lead to an improvement in the pain symptoms, if z. B. intracranial vessels are fused with nerve tracts by scarring z. B. as a result of inflammation.
- Anticonvulsants such as carbamazepine , oxcarbazepine , gabapentin or pregabalin are often effective
- Tricyclic antidepressants such as amitriptyline are often very helpful.
- Behavioral therapy procedures are recommended. Goal: Reduction of fears and achievement of a realistic assessment of the pain quality and pain management (Paulus et al., 2002).
- The only two drugs that have been systematically investigated in studies ( phenelzine and dothiepin ) are not approved in Germany. These are antidepressants .
In drug therapy with analgesics , care should be taken to ensure that they are used sensibly and in a dosed manner, as the risk of drug-induced headache should not be neglected.
literature
- S1 guideline on persistent idiopathic facial pain of the German Society for Neurology . In: AWMF online (as of 2012)
- Klaus Poeck, Werner Hacke: Neurology. 11th edition, Springer, 2001, p. 430.
- Marco Mummenthaler, Heinrich Mattle: Basic Neurology Course. Thieme, 2002.
- J. Klingelhöfer, M. Rentrop: Clinical guidelines for neurology, psychiatry. P. 252.
