Facial pain

Adults Nasal congestion or obstruction, nasal/postnasal discharge or purulence, facial pain or pressure (especially unilateral in a sinus area), diminished sense of smell, fever, cough, maxillary dental pain, fatigue, ear fullness or pain... 

Clinical improvement should be evident by 72 hours of therapy, as demonstrated by defervescence, reduction in nasal congestion and discharge, and improvements in facial pain or pressure and other symptoms. Patients should be monitored for common adverse events and referred to a specialist if clinical response is not obtained with first- or second-line therapy. Referral is also important for recurrent or chronic sinusitis or acute disease in immunocompromised patients. Surgery may be indicated in complicated cases. 

Facial pain, personality change, and ocular disturbances (photophobia, light flashes, halos around bright objects, yellow or green color perception) may be noted. 

Nicol, C.F. A four year double blind study oftegretol in facial pain, Headache 1969, 9, 54-57. 

Gilbert, S. D., Clark, T. M., Flores, C. M. Antihyperalgesic activity of epibatidine in the formalin model of facial pain, Pain 2001, 89, 159-165. 

The Headache Classification Committee of the International Headache Society (1988) has developed diagnostic criteria for classification of headache disorders, cranial neuralgias, and facial pain the criteria include painful and nonpainful disorders of the entire head and are based on the diagnosis rather than on the underlying pain mechanisms. 

Trigeminal neuralgia, an episodic facial pain syndrome, occurs most often in elderly patients. Unilateral paroxysms of severe shooting pain in one or more divisions of the trigeminal nerve are... 

Mr JC has had a greenish yellow discharge for the last 3 days together with facial pain around the eyes and nose. He complains of a loss of sense of smell and taste since having the cold symptoms last week. He has not developed a temperature. What is the possible diagnosis ... 

A 14-year-old boy with Tourette s syndrome developed withdrawal dystonia while being treated with pimozide 12 mg/day. Increased blinking, facial pain, dystonic movements, and other facial movements at each dose reduction pointed toward withdrawal dystonia rather than toward a worsening of Tourette s syndrome. 

Cranial and peripheral nerve injuries Bleeding or infection at wound site Headache Facial pain... 

De Marinis et al. 1991 Ille et al. 1995). Very rarely, focal epileptic seizures occur as well as headache (Youkey et al. 1984 Naylor et al. 2003). Facial pain ipsiiaterai to surgery and related to eating is unusual and may in some way be caused by disturbed innervation of the parotid gland (Truax 1989). 

The therapeutic indications for BoNTs are numerous. They are used in the treatment of ophthahnological disorders (strabismus, Duane s syndrome, esotropia/exotropia), movement disorders (focal dystonias, blepharospasm), spasticity, neiuomuscular disorders, pain (headache, myo-facial pain), disorders of the pelvic floor (anal fissures), ear/ nose/throat disorders, cosmetic applications (wrinkles), and hyperhidrosis. The recent explosion in new indications for BoNTs in the treatment of a wide range of medical conditions also brings the possibihty for medical errors in BoNT dosing. Systemic botulism may result from injection of excessive doses of the potent neurotoxin. The most infamous case of systemic botulism involved the paralysis of four Florida patients, including the doctor, treated with BoNTs for wrinkles. The physician used non-FDA approved formulations of type A from Toxin Research International,... 

There are many pharmaceutical products widely used in medicine and dentistry that contain phenol, sometimes in fairly high concentrations. Bonain s local anesthetic mixture, combining menthol, cocaine and phenol, is well known, and is used, for example, as an intranasal analgesic treatment for certain facial pains. Other products containing phenol include hemorrhoid creams, chilblain solutions, ear drops or wax remover drops, psoriasis treatments, and mouth sprays with phenol in concentrations ranging from 3 mg/ml to 50 mg/g. Applying these products locally introduces only a small quantity of phenol into the organism at well-spaced intervals, and does not appear to cause intoxication. 

Dental/maxillofacial surgery. Surgery relating to the teeth, jaw, face, and its structures. Studies in these areas include acute and chronic dental pain, oral cavity cancer, oral facial pain, oral medicine, and saliva and salivary gland dysfunction. 

Transcutaneous electrical nerve stimulation (TENS) has shown moderate success in managing surgical, traumatic, and oral-facial pain. Although opioid-like side effects certainly are prevented, this technique has not gained wide acceptance in acute pain. 

Cluster headache and other trigeminal autonomic cephalalgias Other primary headaches Headache attributed to head and/or neck trauma Headache attributed to cranial or cervical vascular disorder Headache attributed to non-vascular intracranial disorder Headache attributed to a substance or its withdrawal Headache attributed to infection Headache attributed to disorder of homeostasis Headache or facial pain attributed to disorder of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth, or other facial or cranial structures Headache attributed to psychiatric disorder Cranial neuralgias and central causes of facial pain Other headache, cranial neuralgia, central or primary facial pain... 

As adjunct therapy for headache disorders and acute back pain. In many small clinical trials tizanidine has improved chronic tension headache and facial pain from TMJ, and shown transient improvement in pain of trigeminal neuralgia and low back pain. All these studies are small and short-term. Doses used in these trials were low, mostly 2 mg twice a day. It also may have a role in helping patients wean off narcotics by minimizing withdrawal symptoms. 

Some types of head or facial pain are mediated through three cranial nerves bearing sensory fibers—V, VI, and VII. Most notable among these are trigeminal neuralgia and Bell s palsy. 

Myofascial soft tissue treatment with counterstrain and muscle energy techniques may relieve the facial pain associated with Bell s palsy. The occipitomastoid compression should be released and the temporal bone assisted into normal internal/external rotation. Normal lymphatic flow should be assured by correcting dysfunctions of the cervical spine, cranial motion, and sacrum. C3 should always be evaluated and any dysfunction corrected. 

Persistent somatoform pain disorder Similar to somatisation disorder, but persistent, severe and distressing pain, occurring with psychosocial problems Back pain Tension headache Atypical facial pain... 

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