Head at Orofacial Pain Clinic Israel
Misdiagnosed of toothache can be attributed to several chronic types. This lecture will discusses one major underestimate candidate: Orofacial Migraine (OFM), (previously Neurovascular Orofacial Pain (NVOP)), is often misdiagnosed as persistent idiopathic facial pain (PIFP) or post-traumatic trigeminal neuropathy (PTTN). This lecture will present a retrospective study aimed to reestablish diagnostic criteria for OFM compared to PTTN.
METHODS: Pain and patient characteristics were compared in patients with: OFM, PTTN and OFM with additional trauma (PT-OFM). OFM criteria were based on prior studies; PTTN was defined according to the International Headache Society.
RESULTS: Of the 171 patients in the cohort, 90 had PTTN, 52 had OFM and 29 had PT-OFM. Since all parameters matched, the OFM and PT-OFM groups were combined (T-OFM). T-OFM differed significantly from PTTN (P<0.001) in its periodic pain pattern, presence of autonomic and systemic signs, throbbing pain quality and frequency of bilaterality. Pain quality in PTTN was more burning/stabbing than OFM (P=0.003). Pain severity, location, waking from sleep, muscle sensitivity to palpation and demographics were comparable.
CONCLUSION: OFM differs from PTTN in the periodicity of pain, presence of autonomic and systemic signs, throbbing pain quality and more often being bilateral. OFM diagnosis should be included in the differential diagnosis of all cases of PIFP. Distinguishing OFM from PTTN and PIFP affects treatment and prognosis.