Abstract Body

Headache and facial pain are amongst the most common pain disorders and a common compliant in most pain patients. A proper diagnosis is fundamental for an effective treatment and in recent years there has been significant progress in the understanding and therapy of migraine and other primary headaches. Unlike the rapid development in the headache field, orofacial pain still suffers from little attention. Classification is the simple key to a better understanding of what type of pain it is and how it may be best managed. In this sense, the recent publication of the first internationally accepted classification of facial pain (ICOP) is a major advance and its importance on diagnostic, scientific and treatment of facial pain cannot be overemphasized. Pain in the mouth or face is usually due to pathology of intraoral or adjacent tissue and patients with orofacial pain syndromes typically consult dentists. If no pathology of intraoral tissue including the teeth and mandibular joints is found, a (non-dental) chronic orofacial pain syndrome is diagnosed, a condition that is not well understood and exceptionally difficult to treat. This subgroup of patients is most likely larger and more heterogeneous than previously thought. This is especially alarming as this subgroup of patients has a higher tendency to develop chronic pain conditions and invasive treatment worsens their morbidity¹. In this session ICOP will be introduced and the 4 common pain entities important for neurologists will be discussed.

References:

1. International Classification of Orofacial Pain, 1st edition (ICOP). Cephalalgia 2020; 40: 129–221.

Abstract Body

A number of pain conditions in the head share clinical presentations such as being dull, diffuse, pressing, bilateral and longer-lasting with moderate intensity, often with pain referrals to the neck-shoulder regions, higher prevalence in women before menopause, aggravated by oral functions and stress and associated with considerable psycho-social distress and reduced quality of life. The International Classification of Headache Disorders (ICHD) have well-established criteria for tension-type headache and Headaches attributed to Temporomandbular Disorders (HA-TMD). The Diagnostic Criteria for TMD has set the standards for operationalized, reliable and valid diagnosis of myalgia and myofascial pain related to the jaw muscles and a variant of the HA-TMD diagnosis. Recently also International Classification for Orofacial Pain (ICOP) has proposed subtyping of the muscle pain conditions based on temporal characteristics: acute, infrequent, frequent and chronic occurrence. Nevertheless, the overarching question should be to what extent may underlying pathophysiology vary between these entities and what would the therapeutic implications be? The talk will attempt to review the musculoskeletal orofacial pain conditions, present new findings about the potential overlap and further phenotyping, and critically discuss the clinical ramifications.