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OVERVIEW OF HEADACHES AND FACIAL PAIN

The scope of dentistry has expanded to include not just painful disorders affecting the teeth and jaws, but painful disorders affecting the face, head, and neck.

The position of the American Academy of Orofacial Pain (www.aaop.org) is that "Dentists are uniquely qualified to evaluate and treat intraoral and extraoral pains, including those emanating from associated structures in the head and neck. Patients with complex head and neck pain may present with headaches, neckaches, and facial pain including jaw pain and toothaches."

Headaches are common because there are so many reasons people get them and patients tend to have more than one kind of headache. An important question for patients to be able to answer is "how many kinds of headaches do you have?"

The epidemiology and societal impact of all head, face, and neck pains are not well documented, but the epidemiology and societal impact of migraine is well known and the statistics suggest the pervasiveness of headache and facial pain in our society:

Migraine costs employers $13 billion a year in missed work days and impaired work function
Migraine causes women to miss work and stay in bed an average of 5.6 days per year, and causes men to miss work and stay in bed an average of 3.8 days per year.
The estimated number of missed workdays for all women and men migraineurs is 112 million bedridden days per year.
These statistics apply to patients who have been diagnosed with migraine. These patients account for 39% of all migraine sufferers. 69% of headache sufferers have never been diagnosed and therefore are not included in the statistics discusses above.

These statistics relate to migraine patients only. We do not know how society is impacted if one takes into account all kinds of headaches and facial pains. The following is a more comprehensive list of disorders that can cause headache and facial pain:

1. Neurvascular pain:

a. Migraine - may have an aura consisting of "spots" before your eyes, one-sided or two-sided pulsing headache that may be associtated with either nausea or sensitivity to light and sound.

b. tension-type headache - typically two-sided headache that feels"like a band around my head."

c. cluster headache - extremely severe headache that may feel like a sharp, hot poker behind an eye, with drooping of the eyelid during the headache.

d. chronic paroxysmal hemicrania - similar to cluster headache

2. Neuromuscular pain:

a. TMD-related headache - typically one-sided but may affect both sides. Pain feels like a dull ache that may be worse in the morning or after chewing and talking.

b. cervicogenic headache - may be one or two sided and the sensation is typically a dull ache starting in the neck and patients may feel the referral of pain from the neck or the head and/or face.

3. Neuropathic pain:

a. Trigeminal neuralgia - feels like a brief sharp bolt of electrical pain with burning quality. The pain may occur without provocation but is often triggered by lightly touching the face or inside of the mouth.

b. Neuroma - is a continuous aching pain made worse by touch. The pain may also feel like brief stabs that may also feel like knifing pain.

Overview of Headaches and Facial Pain | What kind of headache/facial pain, do I have?