J Laryngol Otol. 2014; 16: 1-9

Agius AM¹, Jones NS², Muscat R³

1. The Medical School, University of Malta, Msida, Malta
2. Department of Otolaryngology, University of Nottingham, United Kingdom
3. Department of Physiology and Biochemistry, University of Malta

Summary

Patients often present to otolaryngologists with facial pain which has been ascribed to sinusitis in spite of normal nasal endoscopy and sinus CT. This pain has increasingly been recognized as being of neurological origin.

Objectives:A cohort of 240 patients presenting with chronic facial pain was followed up for 36 months. This study aimed to characterize the types of facial pain within this cohort according to International Headache Classification (IHS) criteria and report on their outcome.

The Body Mass Index (BMI), occupation and educational level of this cohort were compared to the general population.

Setting:  An otolaryngological practice on a Mediterranean island.

Results: Tension-type mid-facial pain (MFP) and facial migraine without aura were the commonest types of chronic facial pain. The sites, symptoms and outcome in these two principal groups are discussed. After treating with low dose amitriptyline for eight weeks, nearly half the patients with MFP were symptom-free after three years and a third changed from chronic to episodic pain. The treatment of patients with facial migraine was less uniform but the response rate was similar.

Conclusion: The most effective long-term treatments for tension-type mid-facial pain and facial migraine were low-dose amitriptyline and triptans, respectively.