Orofacial Pain

A Guide for the Headache Physician

Martina K. Shephard, BDent(Hons), MBBS(Hons), FRACDS; E. Anne MacGregor, MD, FFSRH; Joanna M. Zakrzewska, MD, FDSRCS, FFPMRCA

Disclosures

Headache. 2014;54(1):22-39.

Statement of Authorship

Category 1

Conception and Design
Martina K. Shephard, Joanna M. Zakrzewska
Acquisition of Data
Martina K. Shephard, Joanna M. Zakrzewska
Analysis and Interpretation of Data
Martina K. Shephard, E. Anne MacGregor, Joanna M. Zakrzewska

Category 2

Drafting the Manuscript
Martina K. Shephard
Revising It for Intellectual Content
Martina K. Shephard, E. Anne MacGregor, Joanna M. Zakrzewska

Category 3

Final Approval of the Completed Manuscript
Martina K. Shephard, E. Anne MacGregor, Joanna M. Zakrzewska

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Acknowledgment
JZ undertook this work at UCL/UCLHT, who received a proportion of funding from the Department of Health's NIHR Biomedical Research Centre funding scheme.

Abbreviations
AAOP American Academy of Orofacial Pain, GCA giant cell arteritis, ICHD International Classification of Headache Disorders, MMP masticatory myofacial pain, MRI magnetic resonance imaging, NVOP neurovascular orofacial pain, RCT randomized controlled trial, RDCTMD Research Diagnostic Criteria for Temporomandibular Disorders, TMD temporomandibular disorder, TN trigeminal neuralgia

Table. Summary of Management
Management of dental pain
Pulpitis	Removal of irritant, eg, dental caries and restorative or endodontic treatment, or extraction
Cracked tooth	Reducing movement across crack, eg, full-coverage restoration of tooth, may require endodontic treatment or extraction
Dentine sensitivity	Desensitizing agent application, dental restoration to cover exposed dentine
Abscess	Remove source of infection
Management of non-dental intraoral pain
Oral malignancy	Surgical resection ± chemoradiotherapy
Oral malignancy	Opioid analgesia
Inflammatory oral mucosal disease	Topical anti-inflammatory agents
	Systemic and topical steroids
	Systemic immunosuppressants (rarely)
Salivary duct blockage	Sialography, irrigation, and ductal dilatation
	Endoscopic removal of stone
	Lithotripsy of stone
	Antibiotics for infection
	Surgical removal of gland
Trigeminal neuropathic pain	Topical anesthetics
	Tricyclic antidepressants
	Anticonvulsants
	Psychological approaches
Atypical odontalgia	As above
Burning mouth syndrome	Clonazepam
	Tricyclic antidepressants
	Psychological approaches
Management of facial pain with/without intraoral pain
Temporomandibular joint disorder	Conservative management and simple analgesia
	Surgical intervention (in specific scenarios)
	Psychological approaches
Giant cell arteritis	Early initiation of high-dose systemic steroids
Post-herpetic neuralgia	Systemic antiviral medication
	Tricyclic antidepressants
	Anticonvulsants
	Psychological approaches
Trigeminal neuralgia	Carbamazepine/oxcarbazepine
	Lamotrigine, pregabalin
	Microvascular decompression and other ablative procedures
Glossopharyngeal neuralgia	As for trigeminal neuralgia
Glossopharyngeal neuralgia	Surgical management options include microvascular decompression
Anesthesia dolorosa	Tricyclic antidepressants
	Anticonvulsants
	Pregabalin/gabapentin
	or combinations of above drugs
	Psychological approaches
Persistent idiopathic facial pain	Tricyclic antidepressants
	SNRIs
	Cognitive behavioral therapy
Management of headache-related facial pain
Migraine/neurovascular orofacial pain	Acute:
	Simple analgesia/NSAIDs ± anti-emetics
	Triptans
	Preventative:
	Beta-blockers
	Tricyclic antidepressants
	Topiramate/sodium valproate
	Gabapentin
Cluster headache	Acute:
	Oxygen
	Triptans
	Preventative:
	Prednisolone (bridging)
	Verapamil
	Lithium
	Methysergide
SUNCT/SUNA	Lamotrigine
	Oxcarbazepine
	Topiramate
	Gabapentin
	Intravenous lidocaine
Paroxysmal hemicrania	Indomethacin
TMD-related headache	NSAIDs
	Physiotherapy
	Psychological approaches

NSAID = non-steroidal anti-inflammatory drug; SNRI = serotonin-norepinephrine reuptake inhibitor; SUNA = short-lasting unilateral neuralgiform headache attacks with cranial autonomic features; SUNCT = short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing; TMD = temporomandibular disorder

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