The International Classification of Headache Disorders: Accurate Diagnosis of Orofacial Pain?

Abstract

The aim was to apply diagnostic criteria, as published by the International Headache Society (IHS), to the diagnosis of orofacial pain. A total of 328 consecutive patients with orofacial pain were collected over a period of 2 years. The orofacial pain clinic routinely employs criteria published by the IHS, the American Academy of Orofacial Pain (AAOP) and the Research Diagnostic Criteria for Temporomandibular Disorders (RDCTMD). Employing IHS criteria, 184 patients were successfully diagnosed (56%), including 34 with persistent idiopathic facial pain. In the remaining 144 we applied AAOP/RDCTMD criteria and diagnosed 120 as masticatory myofascial pain (MMP) resulting in a diagnostic efficiency of 92.7% (304/328) when applying the three classifications (IHS, AAOP, RDCTMD). Employing further published criteria, 23 patients were diagnosed as neurovascular orofacial pain (NVOP, facial migraine) and one as a neuropathy secondary to connective tissue disease. All the patients were therefore allocated to predefined diagnoses. MMP is clearly defined by AAOP and the RDCTMD. However, NVOP is not defined by any of the above classification systems. The features of MMP and NVOP are presented and analysed with calculations for positive (PPV) and negative predictive values (NPV). In MMP the combination of facial pain aggravated by jaw movement, and the presence of three or more tender muscles resulted in a PPV = 0.82 and a NPV = 0.86. For NVOP the combination of facial pain, throbbing quality, autonomic and/or systemic features and attack duration of > 60 min gave a PPV = 0.71 and a NPV = 0.95. Expansion of the IHS system is needed so as to integrate more orofacial pain syndromes.

A mini review of histological and genetic oral lesions in adult and elderly patients referred to Shiraz Dentistry School

“…Up to a quarter of the population reports OFP (excluding dental pain), and up to 11 % of this is chronic pain. Patients with OFP present to a variety of clinicians because it is associated with significant morbidity and high levels of health care utilization (Aggarwal et al 2006;Bell et al 2008;Benoliel et al 2008;Wirz et al 2010;Zakrzewska and Hamlyn 1999). Severe OFP often is diagnosed as trigeminal neuralgia, with little distinction made between typical or atypical types.…”

Prevalence of parafunctional habits and temporomandibular dysfunction symptoms in patients attending a tertiary headache clinic

“…The most recent studies in the literature emphasize the importance of a multidisciplinary approach towards head and neck pain, including a neurologist and a dental surgeon, both with special skills in assessing these patients [6][7][8] . These recent efforts are generating many new questions regarding classification 9 and treatment 10 of these frequently combined conditions.…”

Persistent Pain after Dental Surgery

“…The International Headache Society (IHS) 7 has published diagnostic criteria for primary and secondary headaches as well as facial pain. Criteria have also been published by the International Association for the Study of Pain (IASP) 8 and by the American Academy of Orofacial Pain (AAOP) 9 , and the Research Diagnostic Criteria for Temporomandibular Disorders 10 covered elsewhere in this issue 11 .…”