Unnecessary extractions in patients with hemicrania continua: case reports and implication for dentistry

Headache and facial pain are both very high in the general population. Headache has been identified as one of the associated conditions in patients with chronic orofacial pain. The interrelation between the two has not been explored in the literature. Patients with facial pain often initially seek the care of a dentist. Misdiagnosis and multiple failed treatments (including invasive procedures) are very common in this population. This case report describes four patients whose condition fulfilled the International Headache Society's criteria for hemicrania continua but whose teeth were extracted because their pain was suspected to be of odontogenic origin. Each patient's records and the literature were reviewed for possible reasons for the unnecessary extractions. The findings suggest that initial treatment with drugs specific for primary headache disorders should be instituted before subjecting patients to invasive procedures.