Orofacial Migraine and Neurovascular Orofacial Pain: Response to Treatment-A Pilot Study

Introduction: The International Classification of Orofacial Pain (ICOP) recognizes orofacial migraine (OFM) and neurovascular orofacial pain (NVOP) as migraine-related entities affecting the facial and oral regions. The diagnostic features of OFM and NVOP indicate that there are many similarities between the two. However, we recently demonstrated that NVOP and OFM are two distinct diagnostic entities, confirming the ICOP classification. It was the aim of the present study to examine whether OFM and NVOP differ in response to pharmacotherapy. Materials and Methods: The cohort was made up of 40 patients attending a tertiary orofacial pain clinic. When implementing ICOP criteria, an OFM diagnosis was made in 23 and an NVOP diagnosis in 17. Results: No statistically significant differences between NVOP versus OFM were observed in the global response to standard abortive therapy such as triptans, or NSAIDs. Similarly, no statistically significant differences were found following prophylactic therapy that included beta-blockers, anti-epileptic drugs, and tricyclic antidepressants. Up to 80% of patients responded favorably with ≥50% pain reduction. Conclusions: NVOP and OFM differ in diagnostic characteristics, demonstrating unique features, and were confirmed as two diagnostic entities. However, NVOP and OFM did not differ in their response to abortive or prophylactic treatments. Study limitations include the lack of starting data precluding a more precise pharmacological analysis. The small sample size limits any far reaching conclusions. This is particularly true regarding individual drug efficacy. We were unable to analyze drug and dose responses separately due to data constraints.