Headache and Facial Pain
- Headache is one of the commonest disorders known to human beings. It could range from simple headache due to tiredness or lack of sleep and other simple reasons to a range of well-known headache disorders to even serious underlying life-threatening conditions hence careful history taking, and examination are paramount when dealing with headache disorder.
- Headache could be really debilitating and too recurrent to interfere with daily functioning. One of those very commonly known headache disorders is Migraine.
- Migraine doesn’t hide any serious underlying pathology yet could be too frequent and too severe to compromise quality of life and daily functioning.
- Management starts by careful diagnosis based on history taking and exclusion of any suspected serious disorders. It’s more common in women than men. It could be precipitated by number of factors including certain types of food and stress. Patients could have aura of visual and/or auditory symptoms before the attacks but sometimes attacks could happen without any aura. Patients could experience nausea, vomiting and sensitivity to light preferring to stay in dark quiet room. Attacks could carry on for variable duration of time and could be too frequent to compromise functioning and quality of life.
- Management largely aims at avoiding precipitating factors, modifying any habits that could be contributing factors and prevention of attacks first place using prophylactic medications. When attacks happen, treatment using Triptans, and simple pain killers is the way forward. Unlike what’s expected, using a lot of pain killers could worsen headache and sometimes stopping them could improve the condition.
- Among the valid treatments that Dr Alkholany offer for such group of patients is Botox injection that could be repeated every 2-3 months with excellent results.
- Occipital nerve block using local anaesthetic and steroids guided by ultrasound as day case procedure with or without pulsed radiofrequency is another option that helps achieve excellent results and minimise severity and frequency of attacks.
- Facial pain is another challenging problem to diagnose. Reasons for facial pain are usually simple not hiding any sinister pathology yet sometimes could reflect something serious thus careful history taking, examination and sometimes imaging is needed. The source could be variable from teeth to temporomandibular joints, to nasal sinuses to nerves supplying the face…etc.
- One of the well-known phenomena that could cause facial pain is what’s known as trigeminal neuralgia which is abnormal functioning of one of the so-called cranial nerves (5th) that arise from the brain. Diagnosis is largely clinical based on specific criteria that could overlap with many similar disorders. When diagnosis is confirmed, management is stepwise starting with the use of medications that could control symptoms to interventional procedures aiming at the trigeminal nerve at different levels to even neurosurgical interventions under care of neurosurgeons in very specific cases where the trigeminal nerve has contact with an aberrant artery that’s irritating it causing it to fire in an abnormal way. Reaching this aetiology needs advanced imaging techniques such as magnetic resonance imaging with contrast to prove or disprove this possibility.
- In diagnosis and management of headache and facial pain we commonly cooperate with our neurology and neurosurgery colleagues and also with other colleagues such as ENT, dental and max Fax as indicated to reach accurate diagnosis that guides and informs right successful management of such kind of disorders.
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