Symptom Finder - Facial Pain
FACIAL PAIN
Visualize the structures of the face in a systematic fashion to develop a differential diagnosis of facial pain. With the skin, herpes zoster and carbuncles come to mind. Next, the internal maxillary artery suggests histamine cephalalgia and arteritis, just as the nerves suggest trigeminal neuralgia, herpes zoster, and the atypical facial neuralgias encountered in multiple sclerosis, Wallenberg syndrome, and other central nervous system conditions. These will almost invariably be associated with other neurologic findings. With reference to the bones, one should recall temporomandibular joint (TMJ) syndrome, sinusitis, and dental caries or abscesses. An elongated styloid process may cause facial pain (Eagle syndrome). Disorders of the eye that cause face pain are included in the section on eye pain.
Of course, one could apply the mnemonic VINDICATE to the differential diagnosis and come up with an extensive list. Thus, V— Vascular conditions suggest histamine cephalalgia; I—Inflammatory conditions suggest herpes zoster, sinusitis, and dental abscesses; and N— Neoplasms suggest Schmincke tumors, carcinoma of the tongue, and so forth. This procedure, however, is more involved than is necessary.
Approach to the Diagnosis
The approach to the diagnosis of face pain includes a careful history and physical examination with a good neurologic examination. The sinuses are transilluminated, and x-rays may be performed. The teeth and occlusion are examined carefully and possibly x-rayed. A histamine test may be indicated to rule out histamine cephalalgia. The busy physician may want to refer the patient to a neurologist immediately, but this will obviously take away the challenge.
Other Useful Tests
1. Therapeutic trial of sumatriptan (migraine)
2. Therapeutic trial of carbamazepine (Tegretol) (trigeminal neuralgia)
3. Temporal artery compression (migraine)
4. Sedimentation rate (temporal arteritis)
5. X-rays of the TMJ (TMJ syndrome)
6. CT scan of the brain (tumors)
7. CT scan of the sinuses (sinusitis)
8. Nasopharyngoscopy
9. Magnetic resonance imaging (MRI) of the TMJ (TMJ syndrome)
10. Spinal fluid analysis (multiple sclerosis)
Visualize the structures of the face in a systematic fashion to develop a differential diagnosis of facial pain. With the skin, herpes zoster and carbuncles come to mind. Next, the internal maxillary artery suggests histamine cephalalgia and arteritis, just as the nerves suggest trigeminal neuralgia, herpes zoster, and the atypical facial neuralgias encountered in multiple sclerosis, Wallenberg syndrome, and other central nervous system conditions. These will almost invariably be associated with other neurologic findings. With reference to the bones, one should recall temporomandibular joint (TMJ) syndrome, sinusitis, and dental caries or abscesses. An elongated styloid process may cause facial pain (Eagle syndrome). Disorders of the eye that cause face pain are included in the section on eye pain.
Of course, one could apply the mnemonic VINDICATE to the differential diagnosis and come up with an extensive list. Thus, V— Vascular conditions suggest histamine cephalalgia; I—Inflammatory conditions suggest herpes zoster, sinusitis, and dental abscesses; and N— Neoplasms suggest Schmincke tumors, carcinoma of the tongue, and so forth. This procedure, however, is more involved than is necessary.
Approach to the Diagnosis
The approach to the diagnosis of face pain includes a careful history and physical examination with a good neurologic examination. The sinuses are transilluminated, and x-rays may be performed. The teeth and occlusion are examined carefully and possibly x-rayed. A histamine test may be indicated to rule out histamine cephalalgia. The busy physician may want to refer the patient to a neurologist immediately, but this will obviously take away the challenge.
Other Useful Tests
1. Therapeutic trial of sumatriptan (migraine)
2. Therapeutic trial of carbamazepine (Tegretol) (trigeminal neuralgia)
3. Temporal artery compression (migraine)
4. Sedimentation rate (temporal arteritis)
5. X-rays of the TMJ (TMJ syndrome)
6. CT scan of the brain (tumors)
7. CT scan of the sinuses (sinusitis)
8. Nasopharyngoscopy
9. Magnetic resonance imaging (MRI) of the TMJ (TMJ syndrome)
10. Spinal fluid analysis (multiple sclerosis)
