Sharav Yair, Katsarava Zaza, Charles Andrew
1 Department of Oral Medicine, Sedation & Maxillofacial Imaging, School of Dental Medicine, Hebrew University-Hadassah, Jerusalem, Israel.
2 Department of Neurology, University of Essen, Essen, Germany.
Cephalalgia. 2017 Jun;37(7):714-719. doi: 10.1177/0333102417705374. Epub 2017 Apr 11.
Background Many patients with mid-face or lower face craniofacial pain are diagnosed, based on accompanying signs and symptoms and features other than location, as either atypical migraines or atypical TACs. Distinguishing features of headache disorders as a cause of facial pain include the temporal pattern of pain, associated symptoms including light and sound sensitivity and nausea, cranial autonomic symptoms, and the lack of local triggering among others. Results An intraoral neurovascular pain has been observed, and was termed neurovascular orofacial pain (NVOP). Due to its location, and signs imitating dental pulpitis, it has great diagnostic and therapeutic importance for differentiating NVOP from dental pathology. The hypothesized mechanism is neurogenic inflammatory activation within the space confined by dentine around the dental pulp, expressed in strong paroxysmal pain and typical allodynia to cold foods. Conclusion Facial manifestations of headache disorders and primary facial pain disorders share common trigeminal nerve input, yet they are highly distinct disorders. Somatotopic segregation may occur at the level of the trigeminal nucleus, thalamus, and somatosensory cortex, and distinct ionic or neurochemical signaling pathways may be involved. Further investigation of facial presentations of headache disorders has the potential to provide new insight into the interface between headache and facial pain.
许多中面部或下面部颅面部疼痛患者，根据伴随的体征、症状以及位置以外的特征，被诊断为非典型偏头痛或非典型三叉自主神经性头痛（TACs）。作为面部疼痛病因的头痛疾病的鉴别特征包括疼痛的时间模式、包括对光和声音敏感以及恶心等相关症状、颅神经自主症状以及缺乏局部触发因素等。结果：观察到一种口内神经血管性疼痛，并将其称为神经血管性口面部疼痛（NVOP）。由于其位置以及模仿牙髓炎的体征，对于将NVOP与牙科病理状况相鉴别具有重要的诊断和治疗意义。推测的机制是牙髓周围牙本质所限定空间内的神经源性炎症激活，表现为强烈的阵发性疼痛以及对冷食的典型痛觉过敏。结论：头痛疾病的面部表现与原发性面部疼痛疾病共享共同的三叉神经输入，但它们是截然不同的疾病。躯体定位分离可能发生在三叉神经核、丘脑和躯体感觉皮层水平，并且可能涉及不同的离子或神经化学信号通路。对头痛疾病面部表现的进一步研究有可能为头痛与面部疼痛之间的界面提供新的见解。
