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Paroxysmal hemicrania: A diagnostic challenge presenting as orofacial pain: A case series
Anas Al-Taee1, Jack Botros2, Beth R Groenke3
1Department of Dentistry, Pines Health Services & Cary Medical Center, Caribou, ME, USA.
Objective:
To present a rare presentation of paroxysmal hemicrania (PH) in the orofacial region.
Methods:
A retrospective record review was performed using the International Classification of Headache Disorders criteria for PH. Inclusion criteria were initial diagnosis of PH and at least one confirmatory diagnosis at follow-up.
Results:
Four patients were diagnosed with orofacial PH 2015-2021. Average age was 56.5 years. Patients were most seen by dentists (n=7) and neurologists (n=5) and had a median of 19.5 months of diagnostic delay. Pain intensity was severe, episodes occurring daily and lasting 4-90 minutes. Lacrimation was the most common autonomic feature. All patients presented with intraoral pain and temporomandibular disorders. Maximum indomethacin dosage ranged from 75-225 mg/day. Verapamil was the most effective adjuvant therapy.
Conclusions:
Orofacial PH presents a diagnostic challenge with significant delays, multiple referrals and unconventional pain locations. Intolerance to indomethacin resulted in the need for adjuvant treatment modalities.
