Headache & Facial Pain

A good history is never more important than here, in trying to untangle the many different types of headpain. Apart from the headache types mentioned specifically, other syndromes include Cluster headache, Giant Cell Arteritis & low pressure headache (under-diagnosed)

1. Migraine

This is an extremely common cause of intermittent headache. Typically attacks start in childhood or adolescence, occur once or twice a month and last hours to days. Only occasionally triggered by food, alcohol, exercise and hormones, the commonest cause is stress.

Headache is severe, throbbing in type often one-sided but may be diffuse. Associated features include nausea, often vomiting, and sensitivity to light, sound and certain smells particularly perfume. Worsened by movement, people need to take time off work and they like to lie down in a dark quiet room and sleep.

Some peoples' attacks may be preceded by a warning which typically spreads and builds over 20-30 minutes. Usually visual, such as zig-zags, flashes or shimmering light, or simply bits missing, less often this warning produces tingling or numbness, limb weakness, problems with speech and psychic experiences.

Management includes reassurance, drugs for the acute headaches themselves, and if frequent, preventative measures, mainly physical including massage and acupuncture.

2. Tension-type Headache

This sort of headache is very much more continuous and felt on both sides of the head, almost anywhere front, back or sides. Often described as a tight ache, pressure, and a clamp or band-like discomfort as if wearing an ill-fitting hat. Usually mild, there may be some minor associated nausea and light sensitivity. More often other features include lack of concentration, dizziness and neck-ache & stiffness. There is little response to drug treatment and often there is medication misuse.

The thrust of management is physical treatment and stress management.

3. Facial Neuralgia

The commonest form of this is trigeminal neuralgia (or Tic Doloreux). Short-lived sharp pains shoot from the corner of the mouth to either the ear or eye on the same side. Episodes tend to last days or weeks and have a nasty habit of recurring after many months or if lucky several years. For certain this is a very severe and distressing condition often driving big men to tears. Unfortunately the cause of this nasty facial pain is largely unknown though rarely it is due to multiple sclerosis.

Management is with drugs, or injection therapy, or operations on the sensory nerve of the face.