Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
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Orofacial pain syndromes have traditionally been divided into two groups: the typical neuralgias and atypical facial pain. While typical neuralgias are well characterised, the term atypical facial pain (now persistent idiopathic facial pain) covers a variety of poorly defined head and face pains whose aetiological mechanisms are poorly understood. This paper examines the characteristics and nosography of these conditions, and suggests they should not be considered as neuralgias (section 13 of the 2004 IHS classification) but as other primary headaches (section 4).
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Painful ophthalmoplegia (PO) is an important presenting problem to ophthalmologists and neurologists. The etiological differential diagnosis is extensive, including different syndromes and causes (vascular, neoplastic, infectivous, inflammatory). ⋯ Some rare causes of PO, such as Tolosa Hunt syndrome with negative neuroimaging findings or ophthalmoplegic migraine remain till now of uncertain classification. Correct approach to the patient requires correlation to clinical data and careful monitoring, to avoid diagnostic mistakes, as the "history" of Tolosa-Hunt syndrome has underlined.
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Neuralgia denotes a sharp, shooting, lancinating pain that is momentary but characteristically recurs. It may be precipitated by touch to a sensitive area ("trigger zone"), or may occur spontaneously. ⋯ Neuralgias may follow nerve trauma, herpes zoster infections or may arise spontaneously. The management of this group of painful conditions is complicated by the area of the body involved and the interaction of organic and psychological factors.
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Case Reports
Ear acupuncture in the control of migraine pain: selecting the right acupoints by the "needle-contact test".
There is increasing evidence that somatic acupuncture can be helpful in migraine treatment, but substantial data on ear acupuncture (EAP) are still lacking. EAP can be useful both in the diagnosis and in the treatment of many medical conditions. As regards the control of migrainous pain, we present a case report in which a procedure called the "needle-contact test" is described in detail. ⋯ In this positive case, the same testing needle can be immediately used for therapy, completely penetrating the skin, and then extracted after about 30 min. Alternatively, a temporary needle can be implanted and left in situ for a variable period of time (1-15 days). This innovative technique allows the identification, with maximum accuracy, of the most effective ear acupoints on migraine pain during acute attacks.
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Comparative Study
A clinical comparison of trigeminal neuralgic pain in patients with and without underlying multiple sclerosis.
Despite clinical similitude, there is a tendency to consider trigeminal pain in multiple sclerosis (MS) as a distinct condition. To evaluate clinical differences in trigeminal pain presentation in patients with and without underlying MS, we compared clinical characteristics of facial pain found in 15 consecutive MS patients with those reported by 13 consecutive subjects diagnosed with classical trigeminal neuralgia. The only significant difference between MS and non-MS neuralgic patients was the age of onset of pain (43.4+/-10.5 in MS vs. 59.6+/-11.50 in non-MS patients, p=0.000629, unpaired Student's t-test). ⋯ Only one patient in the MS group presented with long-lasting episodes (45-60 min) of atypical odontalgia. Our findings support the view of a common pathogenetic mechanism underlying TN in the two groups, possibly related to demyelination of the trigeminal entry root in the pons. Typical TN in MS patients should be considered as "symptomatic trigeminal neuralgia".