Neurovascular Orofacial Pain Flashcards
What is neurovascular OFP?
OFP caused by interaction between nervous and vascular systems
Subgroup of neurovascular craniofacial pain (like cluster headaches and trigeminal autonomic cephalgia)
Why is it important to identify Neurovascular OFP?
It can cause extraction of teeth that shouldn’t be extracted.
What are the clinical features of neurovascular OFP?
Usually starts in the mouth and then starts to show up extraorally.
Often is unilateral
Quality and pattern: Is often moderate - strong pain that acts episodically in high frequency and can last from minutes to hours.
Has a chronic variant characterized by unremitting pain
Causes tearing, nasal congestion, and swelling/fullness
Perioral facial pain, throbbing quality, autonomic/systemic features and attack lasting >60 minutes
What are the diagnostic criteria for neurovascular OFP?
At least 5 attacks of facial pain
Severe, unilateral oral and or perioral pain (can refer to the orbital and/or temporal regions but rarely bilateral)
At least one of: Toothache with no local pathology, Throbbing, Wakes. (Frequent painful vital teeth tha are hypersensitive to cold. Some teeth may have RCT with no relief.
Episodic attacks lasting 60 mins to 24 hours
Accompanied by: Ipsilateral lacrimation, ipsilateral rhinorrhea and/or congestion
Photo/phonophobia
Ipsilateral cheek swelling/fullness
Nausea and/or vomiting
Where is neurovascular OFP most common?
Onset 35 - 50 years
F>M
Often migraines in Hx or family Hx
How is neurovascular OFP treated?
Low dose amitriptyline (TCA)
Beta-blockers
Ergotamine (anti-migraine meds)
SSRIs
Botox
Choice depends on other comorbidities
