Idiopathic Non-Dental Facial Pain Syndromes in Italian Children: A Clinical Case Series

Abstract

Background. The orofacial pain syndromes (OFPs) are a heterogeneous group of syndromes characterized by painful attacks involving the orofacial structures. They may be summarily subdivided into two great categories: (1) orofacial pain mainly attributed to dental disorders such as dentoalveolar and myofascial orofacial pain or temporomandibular joint (TM) pain; (2) orofacial pain mainly attributed to non-dental pain as neuralgias, facial localization of primary headaches or idiopathic orofacial pain. The second group is uncommon, often described by single case reports, can often show overlapping symptoms with the first group, and represents a clinical challenge, carrying the risk of undervaluation and possibly invasive odontoiatric treatment. We aimed to describe a clinical pediatric series of non-dental orofacial pain and better to underline some topographic and clinical features associated with them. We retrospectively collected the data of children admitted to our headache centers (Bari, Palermo, Torino) from 2017 to 2021. Our inclusion criterion was the presence of non-dental orofacial pain following the topographic criteria of 3° International Classification of Headache Disorders (ICHD-3), and exclusion criteria included the pain syndromes attributed to the dental disorders and pain syndromes due to the secondary etiologies Results. Our sample comprised 43 subjects (23/20 M/F, in the range of ages 5–17). We classified them int: 23 primary headaches involving the facial territory during attacks, 2 facial trigeminal autonomic cephalalgias, 1 facial primary stabbing headache, 1 facial linear headache, 6 trochlear migraines, 1 orbital migraine 3 red ear syndrome and 6 atypical facial pain. All patients described debilitating pain for intensity (moderate/severe), 31 children had episodic attacks, and 12 had continuous pain. Almost all received drugs for acute treatment (less than 50% were satisfied), and some received non-pharmacological treatment associated with drug therapy Conclusion. Although rare OFP can occur in pediatric age, it can be debilitating if unrecognized and untreated, affecting the psychophysical well-being of young patients. We highlight the specific characteristics of the disorder for a more correct and earlier identification during the diagnostic process, already difficult in pediatric age, and to define the approach and possible treatment to prevent negative outcomes in adulthood.

Orofacial Migraine and Other Idiopathic Non-Dental Facial Pain Syndromes: A Clinical Survey of a Social Orofacial Patient Group

“…Furthermore, these data show how primary headaches in adulthood can have an orofacial localization, as already seen in pediatric ages [13,14], so this localization should not exclude headaches such as migraines or TACs from the differential diagnosis. There are several limitations to this study.…”

“…This aspect must be kept in mind because these patients could be mistakenly subjected to invasive interventions, especially dental ones. Furthermore, Ziegler and May [2] recently pointed out that the current upper limit for defining pain as orofacial and not as headache (orbitomeatal line) could easily include many TACs and migraines (trochlear migraine [13,14]) as orofacial pains, and these authors, therefore, suggest a modification of this limit [2] Even more interesting is the almost complete absence in our sample of persistent idiopathic facial headache (PIF), which accounts for a significant proportion of clinical cases at specialized centers [6,11,15]. There may be several reasons for explaining these conflicting data:…”