Classification of Head, Neck, and Face Pains First Edition (WHS-MCH1): Position paper of the WHS Classification Committee

Radiologic Findings and Outcomes of Hyoid Compression Syndrome

Background. Due to the COVID-19 pandemic and the lockdown, most people with headache and neck pain were unable to access health care services, so it is unclear which remote physiotherapy methods would be effective in treating neck and head pain.
 Aim. To investigate the effects of virtual facial exercise and self-massage on women’s neck and head pain and functional condition.
 Methods. The study included 33 women 45–59 years old, who had experienced neck and head pain in the past month and were not taking pain medications. All subjects were in the experimental group. Facial exercise and self-massage for 20 minutes daily for 20 days were performed by the subjects following virtual instructions. Before and after the intervention, the intensity of neck and head pain was assessed using numeric pain intensity scale, the quality of life was assessed using neck disability index and headache disability index.
 Results. Neck pain decreased by 3.82 ± 2.63 points (p < 0.05), headache decreased by 2.82 ± 1.93 points (p < 0.05), neck functional disability decreased by 7.33 ± 4.57 points (p < 0.05), headache disability index values decreased by 15.57 ± 8.47 points (p < 0.05).
 Conclusion. After the application of virtual facial exercise and self-massage, women’s neck and head pain was reduced and the quality of life improved.
 Keywords: neck pain, headache, physiotherapy, massage, quality of life.

This is a review of current concepts of chronic post-traumatic neck and head pain. In this article, I will emphasize the physiological and sociological aspects of these disorders. The pathophysiology of chronic post-traumatic neck and head pain has not been well understood. Some have emphasized the organic factors and others the psychogenic aspects of these conditions. Only in recent years have this dichotomy been integrated with sociocultural concepts. The history of chronic post-traumatic head and neck pain is reviewed. Paradoxes are discussed, ie, the great differences in prevalence around the world, the inconsistent relationship of symptoms to degree of trauma, the curious phenomena of structural disease without symptoms, and symptoms without structural disease. The organic and pathophysiologic factors are reviewed, then those factors that modulate pain in these conditions are discussed. Chronic post-traumatic neck and head pain is rarely either organic or psychogenic. Rather physiological, social, and cultural factors play major roles in modulating pain and either perpetuate or ameliorate these chronic pain conditions.

Spontaneous dissection of the cervical internal carotid artery (sICAD) causes, in more than 90% of patients, carotid territory ischemia, local signs and symptoms on the side of dissection, or both, whereas the remaining sICAD remain clinically asymptomatic. Local signs and symptoms include head, facial, or neck pain, Horner syndrome, pulsatile tinnitus, and cranial nerve palsy. Head, facial, or neck pain occurs in 64-74% and is the presenting symptom in up to 58.5%, and the only manifestation in 2.2-4.5%. Headache is observed in 65-68%, facial pain in 34-53%, and neck pain in 9-26%. Horner syndrome consisting essentially of miosis and ptosis is detected in 28-41%. Cranial nerve palsy is reported in 8-16%; the lower cranial nerves IX-XII are most commonly affected, in particular the hypoglossal nerve. The facial nerve may also be involved; dysgeusia results mainly from involvement of the chorda tympani (0.5-7.0%) or the glossopharyngeal nerve. Transient pareses of the ocular motor (III, IV and VI) and trigeminal nerves have been observed. Pulsatile tinnitus is reported in 16-27%. About three quarters of sICAD cause ischemic events, which include ischemic stroke in 80-84%, transient ischemic attack in 15-16%, amaurosis fugax in 3%, ischemic optic neuropathy in 4%, and retinal infarct in 1%. Patients with sICAD causing ischemia show a lower prevalence of Horner syndrome and palsy of the caudal cranial nerves than patients with sICAD causing no ischemic events, whereas headache, neck pain, and pulsatile tinnitus are equally frequent in both groups. After an ischemic stroke, independency defined by a moderate Rankin scale score of 0-2 occurs in 63-90%, whereas the outcome of retinal infarct and ischemic optic neuropathy are not well known.

This article describes chronic secondary headache and chronic orofacial pain (OFP) disorders with respect to the new International Classification of Diseases (ICD-11). The section refers extensively to the International Classification of Headache Disorders (ICHD-3) of the International Headache Society that is implemented in the chapter on Neurology in ICD-11. The ICHD-3 differentiates between primary (idiopathic) headache disorders, secondary (symptomatic) headache disorders, and OFP disorders including cranial neuralgias. Chronic headache or OFP is defined as headache or OFP that occurs on at least 50% of the days during at least 3 months and lasting at least 2 hours per day. Only chronic secondary headache and chronic secondary OFP disorders are included here; chronic primary headache or OFP disorders are listed under chronic primary pain syndromes that have been described in a companion publication. The subdivisions of chronic secondary OFP of ICHD-3 are complemented by the Diagnostic Criteria for Temporomandibular Disorders and contributions from the International Association for the Study of Pain Special Interest Group on Orofacial and Head Pain and include chronic dental pain. The ICD-11 codes described here are intended to be used in combination with codes for the underlying diseases, to identify patients who require specialized pain management. In addition, these codes shall enhance visibility of these disorders in morbidity statistics and motivate research into their mechanisms.

Cross-sectional epidemiological study. To determine the 1-year prevalence of neck pain and low back pain in the Spanish population and their association with sociodemographic and lifestyle habits, self-reported health status and comorbidity with other chronic disorders. No recent population-based epidemiological studies have estimated the prevalence of neck and low back pain in Spain. We analyzed data obtained from adults aged 16 years or older (n = 29,478) who participated in the 2006 Spanish National Health Survey, an ongoing, home-based personal interview which examines a nation-wide representative sample of civilian noninstitutionalized population residing in main family dwellings (household) of Spain. We analyzed prevalence data of neck and low back pain and their relationship with socio-demographic characteristics (sex, age, marital status, educational level, occupational status, or monetary income), self-perceived health status, lifestyle habits (smoking habit, alcohol consumption, sleep habit, physical exercise, or obesity), and the presence of concomitant chronic diseases or symptoms. The 1-year prevalence was 19.5% (95% CI: 18.9-20.1) for neck pain and 19.9% (95% CI: 19.3-20.5) for low back pain. Both neck pain and low back pain were higher among female (26.4% and 24.5%) than male (12.3% and 15.1%). Subjects in the 31 to 50 years group were 1.5 times (95% CI: 1.3-1.8) more likely to report low back pain than participants in the 16 to 30 years group. Individuals reporting neck or low back pain showed worse self-reported health status (OR: 4.9, 95% CI: 4.5-5.3 for neck pain; OR: 4.7, 95% CI: 4.3-5.1 for low back pain) and were more likely to complain of depression (OR: 4.3, 95% CI: 3.9-4.7 or OR: 3.6, 95% CI: 3.3-3.9, respectively). Further, a strong association between neck and low back pain was found (OR: 15.6, 95% CI: 14.2-17.1). Finally, neck pain and low back pain were also associated with several other chronic conditions, particularly arthrosis (OR: 6.5, 95% CI: 6.0-7.0), and headaches (OR: 4.3, 95% CI: 3.9-4.8) for neck pain, and both arthrosis (OR: 5.7, 95% CI: 5.3-6.2), and osteoporosis (OR: 6.3, 95% CI: 5.6-7.2), for low back pain. This Spanish population-based survey showed that neck and low back pain are prevalent and highly associated between them, more frequent in female (particularly neck pain) and associated to worse self-reported health status. Individuals with neck and low back pain were more likely than those without pain to have depression and other painful conditions, including headache and osteoporosis.

Background Head and neck pain is an atypical presentation of acute aortic dissection. Classic teaching associates this pain with proximal dissections, but this has not been extensively studied.Methods Patients enrolled in the International Registry of Acute Aortic Dissection from January 1996 to March 2015 were included in this study. We analyzed the demographics, presentation, treatment, and outcomes of Type A aortic dissection patients presenting with head and neck pain (n = 812, 25.8%) and compared it with those without these symptoms (n = 2,341, 74.2%).Results Patients with head and neck pain were more likely to be white, female, with a family history of aortic disease. Patients with head and neck pain had higher percentages of back pain (43.3% vs. 37.5%,p = 0.005) and chest pain (87.6% vs. 79.3%,p < 0.001). On imaging, a higher percentage of those with head and neck pain had arch vessel involvement (44.3% vs. 38%,p = 0.010) and intramural hematoma (11.7% vs. 8.1%,p = 0.003). Surgical management was more common in patients with head and neck pain (89.8% vs. 85.2%,p = 0.001). Regarding outcomes, patients with head and neck pain had significantly higher rates of stroke than those without head and neck pain (13% vs. 9.9%,p = 0.016); however, overall mortality was lower for those with head and neck pain (19.5% vs. 23%,p = 0.038). Those with head and neck pain only had higher overall mortality compared to those with head and neck pain with chest or back pain (34.6% vs. 19.9%,p = 0.013). A logistic regression of mortality revealed that preoperative hypotension and age > 65 years were significantly associated with increased mortality.Conclusion Presence of head and neck pain in Type A dissection is associated with more arch involvement, intramural hematoma, and stroke. When isolating those with head and neck pain only, there appear to be a higher rate of comorbidity burden and higher overall mortality.

Neck and facial pain in older adults present unique diagnostic challenges because neuropathic and musculoskeletal causes often overlap. Trigeminal neuralgia (TN) is frequently suspected when unilateral facial pain occurs, but myofascial pain originating from the sternocleidomastoid (SCM) muscle can closely imitate TN owing to similar referred-pain pathways. We report an 81-year-old woman who developed right-sided neck and facial pain diagnosed and treated as TN. Detailed examination revealed an SCM trigger point that reproduced her characteristic pain. Conservative management with a short course of muscle relaxants, local heat, and stretching led to complete symptom resolution. This case emphasizes the importance of including myofascial pain syndromes in the differential diagnosis of facial and neck pain, particularly in older adults, to prevent unnecessary long-term use of medications or invasive interventions

The Emerging Specialty of Orofacial Pain

This study evaluated the efficacy of sphenopalatine ganglion pulsed radiofrequency (SPG-PRF) treatment in patients suffering from chronic head and face pain. Thirty patients were observed from 4 to 52 months after PRF treatment. The primary efficacy measures were the reduction in oral medication use, including opioids, time-to-next-treatment modality for presenting symptoms, duration of pain relief, and the presence of residual symptoms. Secondary objectives included the evaluation of adverse effects and complications. All data were derived from patient charts, phone conversations, and clinical follow-up visits. Fourteen percent of respondents reported no pain relief, 21% had complete pain relief, and 65% of the patients reported mild to moderate pain relief from SPG-PRF treatment. Sixty-five percent of the respondents reported mild to moderate reduction in oral opioids. None of the patients developed significant infection, bleeding, hematoma formation, dysesthesia, or numbness of palate, maxilla, or posterior pharynx. A large-scale study of SPG-PRF for the treatment of face and head pain has not been previously reported. Our results suggest that a prospective, randomized, controlled trial study to confirm efficacy and safety of this novel treatment for chronic head and face pain is justified.

Orofacial pain and stylohyoid complex syndrome.

Wish you all a blessed prosperous 2020 and would like to welcome you to “Annals of Headache Medicine”. The headache medicine field continues to be very pertinent and vibrant with the many recent seminal discoveries that substantially challenged our traditional understanding of headaches pathophysiology and shed the light on new neurobiological, mechanistic, and functional insights into headaches. According to the Center for Disease Control and Prevention and National Center for Health Statistics‎1 www.cdc.gov/nchs/data/series/sr_10/sr10_260.pdf; • 14% of adults suffer from migraine or severe headache • 14% of adults suffer from neck pain • 5% of adults suffer from face pain Up to 20% of patients don't respond to or cannot tolerate medications. Therefore; multimodal interdisciplinary approach is paramount for pain relief and to improve function. Based on the above statistics, patients with chronic headaches, neck pain, and orofacial pain outnumber patients with chronic back pain and represent an important public health problem that cannot be ignored anymore. Despite the need to address this public health problem, many physicians and other health care professionals are not adequately educated to contribute to the cultural transformation in the perception and treatment of people with headaches and pain. The need for an interdisciplinary approach and timely interactions between different physicians with unique backgrounds are essential to the success of such cultural transformation. The necessity for this approach prompted the birth of the American Interventional Headache Society (AIHS). The purpose of AIHS (www.interventionalheadache.net/) is to foster awareness, promote, and advance headache, neck and orofacial pain science through research, education, and advanced patient care. With the great success of AIHS, it became quite evident the need for an interdisciplinary headache journal, where healthcare professionals from diverse specialties (neurology, internal medicine, primary care, pain medicine, anesthesiology pain management, neurosurgery, oral surgery, clinical and basic science researchers)have a common platform to share and exchange knowledge, experience, and new research. The AIHS board decided to sponsor a new open access journal - Annals of Headache Medicine (AHM). Open access journals are now established as an integral part of the medical landscape. In fact, it seems likely that in the near future, the majority of medical journals will become open access. While the overall costs of online journals are usually lower than that of print journals, there are real costs associated with editing, formatting, and indexing of online issues. AIHS acknowledges that financial barriers can create a firewall that hinders the widespread exchange of research; accordingly, the publication fee will be waived for all authors. The plan is to have a free submission for the next 2-3 years, and then after the publication fee may be reevaluated and adjusted according to the existing circumstances. Free submission will ensure that the peer review process and editorial decisions will be independent of financial considerations. The provision of an impact factor is delayed for all new journals for obvious reasons. The AHM board is working hard towards generating an impact factor as soon as possible as well as inclusion in major bibliographic databases such as PubMed. We are currently registered at CrossRef and all published manuscripts have designated DOI numbers for citations and referencing. I’m honored to be the founder and first Editor-in-Chief for “Annals of Headache Medicine - AHM”. The trust that AIHS board has bestowed on me will motivate me to do my very best serving our readership. My long professional career in both academia and private practice and my clinical background as headache specialist, anesthesiologist and pain medicine specialist will guide me while navigating my new role. We are committed to the highest scientific and ethical standards. Peer review is the cornerstone for the success of any journal. I would like to personally offer my sincere thanks the associate editors and the editorial board of AHM (www.ahmjournal.com/editorial-board/) who will bring their rich diverse expertise and unmatched dedication to ensure transparent, high quality, and rapid review process.

Magnetic resonance imaging studies were performed in six patients with chronic head and neck pain and in five control subjects to determine whether irreversible atrophic changes resulting in destruction of muscle fibers have a role in patients with chronic pain specific to the cervical spine. Both groups of subjects had medical history obtained and underwent physical examination and proton density-weighted (PD-weighted) magnetic resonance imaging. Subjects with chronic pain had substantial restriction of motion. Axial proton density-weighted images of the rectus capitis major and minor muscles were examined. In the subjects with chronic pain, the muscles had high signal intensity, indicating replacement of dead suboccipital skeletal muscle with fatty tissue. This infiltration was not observed in the control subjects who were free of significant motion restrictions and had no history of recurring neck and head pain. Analysis of pixel intensity values confirmed this finding. The reduction in proprioceptive afferent activity in affected muscles may cause increased facilitation of neural activity that is perceived as pain. At least mean squares algorithm was used to define a linear estimating equation for each subject. Linear regression analysis, using an alpha level < .005, was used to determine how well each subject's data fit the estimating equation. This preliminary work indicates substantial infiltration of fatty tissue into suboccipital muscles of some subjects being treated for chronic head and neck pain.

Associations of alexithymia with temporomandibular pain disorders (TMD), facial pain, head pain and migraine have been described, but the role of the different dimensions of alexithymia in pain development remained incompletely understood. We sought to investigate the associations of alexithymia and its subfactors with signs of TMD and with facial pain, head pain and migraine in the general population. A total of 1494 subjects from the general population completed the Toronto Alexithymia Scale-20 (TAS-20) and underwent a clinical functional examination with palpation of the temporomandibular joint and masticatory muscles. Facial pain, migraine and head pain were defined by questionnaire. A set of logistic regression analyses was applied with adjustment for age, sex, education, number of traumatic events, depressive symptoms and anxiety. Alexithymia was associated with TMD joint pain (Odds Ratio 2.63; 95% confidence interval 1.60-4.32 for 61 TAS-20 points vs the median of the TAS-20 score) and with facial pain severity (Odds Ratio 3.22; 95% confidence interval 1.79-5.79). Differential effects of the subfactors were discovered with difficulties in identifying feelings as main predictor for joint, facial, and head pain, and externally oriented thinking (EOT) as U-shaped and strongest predictor for migraine. Alexithymia was moderately to strongly associated with signs and symptoms of TMD. These results should encourage dental practioners using the TAS-20 in clinical practice, to screen TMD, facial or head pain patients for alexithymia and could also help treating alexithymic TMD, facial or head pain patients.

Pain sensitivity in relation to frequency of migraine and tension-type headache with or without coexistent neck pain: an exploratory secondary analysis of the population study.