In the new ICHD classification, this entity has been named “painful post-traumatic trigeminal DAPT neuropathy.”[18] This term is used to describe a facial pain presentation that does not fit the clinical pattern for any other diagnosis and is relatively rare.[18, 83] It is often continuous, “nagging” and “dull” in nature, and is not restricted by neurological anatomical boundaries.[84, 85] An example of a patient’s description

of the pain is: “Concrete poured into my head and then moving around. There is a high level of associated psychological comorbidity and a high prevalence of chronic pain elsewhere in the body.[5, 32] It is often associated with conditions such as irritable bowel syndrome and chronic widespread pain. The etiology of the condition is unclear, although recent research has suggested the possibility of a pathophysiology similar to trigeminal neuropathic pain.[86, 87] There is often a history of mental health problems that may predate the pain. Management is often difficult and includes medical and psychological input, using a multidisciplinary team approach.88-90 Because of the very broad definition

that has been selleck kinase inhibitor proposed in the new ICHD classification, this diagnosis will continue to be applied to a very heterogeneous group of patients and thus limit further research into the condition.[18] Migraine may manifest as facial pain either because of referral or as a phenomenon referred to as atypical or lower half migraine.[91] Some authors have suggested the presence of a separate entity that they have named neurovascular orofacial pain (NVOP).[92] This is a rare presentation and may mimic a number of other orofacial pain diagnoses. The pain is usually experienced in the distribution of the second or third divisions of the trigeminal nerve and is episodic. Attacks generally last for longer than 60 minutes. It is often described as “throbbing” and may have accompanying autonomic signs or systemic symptoms such as nausea. Patients may also complain of dental sensitivity, selleck inhibitor which can introduce diagnostic difficulties as patients

pursue treatment for a perceived dental source of pain. NVOP has features in common with migraine as well as trigeminal autonomic cephalalgias, and it is suggested that NVOP may represent “relocated” migraine.[93] It is important to differentiate NVOP from dental pulpal pathology, with which it is often confused due to the presence of dental sensitivity during attacks. A case series of 7 lower facial migraines showed that all cases responded to triptans, and 3 responded to migraine prophylactic measures.[94] Case–control studies from a range of different clinical settings are necessary in order to provide more evidence for the presence of this entity, as its management can be substantially different to other orofacial pain diagnoses.