Chronic headache and face pain – causes, types, diagnostics

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Chronic headaches, which appear more or less every day or almost every day, for weeks and months, are less urgent, but just as difficult to diagnose and treat as acute headaches. They can be caused, for example, by a developing brain tumor or facial skull disease.

What is chronic headache?

Chronic headache is pain that occurs practically every day for more than three months. Chronic headache refers to the many types of headache that make it difficult to function normally. The headache can be divided into:

1. primary (spontaneous) – its causes are not fully known;
2. secondary (symptomatic) – headache occurs as a consequence of other systemic or intracranial ailments.

Increasing headache over time may be a symptom of increasing intracranial tightness and should prompt for specialist examinations. Pain that wakes the patient up from sleep or appears shortly after waking up is particularly disturbing. Only after excluding the possible causes of the so-called symptomatic headache and facial pain (brain tumor, diseases of the facial organs, hypertension, glaucoma, etc.) can be considered as a spontaneous headache.

In the case of headache soothing, you can use teas, eg MIGRENKI – herbal and fruit tea with chamomile, lavender and golden gold in the composition.

Causes of chronic headache

For most people, chronic headache is of a primary nature, with chronic migraines and chronic tension headaches being the main causes. In turn, the following are responsible for the occurrence of symptomatic headache:

1. neck or head injuries,
2. viral and bacterial infections,
3. diseases: nose and paranasal sinuses, ears, eyes (e.g. untreated vision defect) and allergic ailments,
4. taking large amounts of painkillers and substances such as alcohol or solvents (or their withdrawal),
5. inflammation around the teeth, mouth and periodontium,
6. intracranial tumors,
7. intracranial hypertension,
8. degenerative diseases of the cervical spine,
9. carotid arteriosclerosis or giant cell arteritis,
10. hypertension,
11. trigeminal or facial nerve neuralgia,
12. kidney disease
13. trouble sleeping,
14. mental disorders.

Tension headache

Chronic tension-type headache is the most common idiopathic chronic headache. It is often called psychogenic pain because it is associated with emotions and stress. It often occurs against the background of mental disorders. Factors that increase the risk of its occurrence include:

1. menstruation,
2. tiredness,
3. excessive tension of the facial muscles,
4. atmospheric factors.

The characteristic feature of tension pain is its bilateral occurrence, especially in the parietal, frontal and occipital areas. Its intensity is usually moderate, it may increase during coughing, crying or daily physical activity, e.g. while cleaning. Patients describe the pain as distracting and dull. Nausea and vomiting are not observed.

Pain in chronic migraine

Chronic migraine is usually a consequence of a migraine without an aura. The pain of migraine is much less severe than that of episodic migraine and does not worsen with exercise. The clinical picture of the ailments is similar to that of chronic tension headache, it is often accompanied by a feeling of chronic fatigue and a depressed mood. Factors that increase the risk of developing episodic migraine into chronic migraine include:

1. head injuries,
2. depression,
3. menopause,
4. stress,
5. chronic fatigue,
6. surgical procedures,
7. meningitis,
8. infections,
9. hypertension.

However, the most common cause remains abuse of painkillers.

Diagnosis of chronic headache

In diagnostics, the diagnosis of the cause of secondary chronic headache is of great importance. It is necessary to conduct a thorough medical interview with the patient about his symptoms. The information obtained helps to differentiate the etiology of daily chronic headache. It is important to identify the nature of the headache, its duration, location and any accompanying symptoms. The doctor then performs a physical and neurological examination. Any abnormalities in these tests are an indication for imaging tests in the form of computed tomography, X-ray of the cervical spine or magnetic resonance imaging. If a symptomatic headache is suspected due to a systemic disease, tests for the underlying disease are performed.

In some cases, it also performs Doppler ultrasound of carotid and vertebral arteries and computed tomography angiography of the carotid arteries, intracranial or vertebral. Especially in patients with suspected disease of the blood vessels supplying the brain. The indication for the examination of the cerebrospinal fluid by lumbar puncture is the suspicion of meningitis.

Treatment of chronic headache

Appropriate cooperation between the patient and the doctor is necessary for affective treatment. In chronic secondary headaches, it is very important to treat the underlying disease that caused the pain (e.g. lowering blood pressure with appropriate medications). Anti-anxiety and antidepressant medications are mainly used in everyday tension headaches. However, the use of drugs alone does not always bring the expected benefits, therefore psychotherapy is suggested as an adjunct treatment.

In patients with chronic migraines, it is necessary to stop taking pain relievers and avoid the triggers of pain. Patients should avoid stressful situations and fatigue.

In addition to pharmacotherapy, prevention is also important. In the prevention of chronic migraine, it is recommended to use:

1. antiepileptic preparations,
2. beta blockers
3. antidepressants
4. botulinum toxin type A injection (intramuscular injection).

What is chronic facial pain?

Pain around the face is quite a common ailment, especially the acute one related to dental problems. The situation becomes uninteresting when the pain in the face becomes chronic. This type of ailment is less common and mainly affects structures other than the teeth. Correct diagnosis by a doctor is not an easy task due to the rare occurrence of chronic facial pain, a large number of causes and symptoms, and the lack of objective diagnostic tests.

Facial pains can have different physiological characteristics. Numerous studies have shown that the structures that cause pain interact with the terminals of the trigeminal nerve via receptors, ion channels and neurotrophins. In patients suffering from chronic idiopathic facial pain, large differences in the response to pain have been shown: decreased blood flow in the prefrontal cortex and increased blood flow in the anterior cingulate cortex. In addition, sexual differences in the peripheral activity of selected chemicals acting through receptors have been proven.

symptoms

Chronic facial pain is described by patients as dull and very distressing. Its sharp exacerbations sometimes occur, especially under the influence of severe stress. It happens that the pain radiates to the neck and head area.

Clinical features of chronic facial pain

1. Chronic facial pain starts on one side of the face and over time spreads to larger areas, sometimes bilaterally. Pain can also affect the top of the neck and the back of the head.

2. The pain is excruciating, sharp and burning. While it is usually permanent, there are periods of relief. It usually occurs at a young age.

3. Chronic facial pain varies in severity from mild to moderate. In most patients, it subsides at night.

4. Pain occurs every day and lasts more than two hours. It is continuous or interrupted.

5. Relief of chronic pain in the face is brought by a large amount of rest and relaxation.

6. Chronic facial pain worsens under the influence of stress and fatigue.

The reasons

Chronic facial pain may coexist with other ailments and factors:

1. irritable bowel syndrome,
2. mental disorders,
3. injury,
4. damage to the peripheral nerve,
5. minor surgery to the teeth, face, jaw or gums.

Diagnostics

During the diagnosis, it is necessary to thoroughly examine the physical and pain symptoms. Radiographic examination of the skull and sinuses is performed, and the skull base is assessed using computed tomography. A diagnosis of chronic facial pain can be made when other causes are excluded.

Treatment of chronic facial pain

Pharmacological treatment is used. Tricyclic antidepressants are used, the effectiveness of which has been confirmed by randomized trials. Less pain intensity has been observed in patients treated with low doses of amitriptyline. When taken at a dose of 20 mg per day in patients with chronic facial pain (not depressed), foxetine also provided pain relief.

Not only drugs play a significant role in improving the patient’s condition. It is also important to properly educate patients about the cause of chronic facial pain and to undertake an appropriate form of therapy with the patient that will bring success to treatment. There is talk of a certain role of psychotherapy in the treatment of pain, especially behavioral-cognitive therapy, but studies have not clearly confirmed its effectiveness. Psychotherapy is strictly implemented in patients with chronic facial pain who show visible personality disorders. Some therapeutic effect was also observed after the use of hypnosis.

Treatment of chronic facial pain is generally very difficult, not only because of the physical aspect of the disease, but also because of the emotional nature. It is impossible to cure a patient with one drug, hence the importance of multidirectional treatment and patient education about the nature of the disease. A better therapeutic effect is obtained with an appropriately earlier diagnosis and treatment implemented as quickly as possible.