Abstract
Background It is not so infrequent that a patient reports severe pain with a clear focus in/around the eye that looks like an atypical facial pain/persistent idiopathic facial pain. All the patients fulfilled DMS-IV criteria for depression or bipolar disorder-I and sleep and benzodiazepines overuse were reported as the only escape and cure treatment. This may or may not appear as a psychological flight reaction characterized by vegetative signs [1], or a medication-overuse headache. The diagnosis could be wrong even though the IHS/IASP and psychological criteria were respected. What could be the problem? We did not take into account that demodex is present even in man. Demodex -type A and type B-, the most serious non-neoplastic dermatological disease [2,3], is not so widely known in human pathology [4]. This ascaris provokes discomfort and pain, the severity of which depends on the extent and seriousness of the disease [2-4], as well as on the pain proneness evidenced in third hyperalgesia test we proved several years ago [5]. Thus, pain proneness and pain redundancy might be present in both migraine sufferers and in their relatives.
Highlights
It is not so infrequent that a patient reports severe pain with a clear focus in/around the eye that looks like an atypical facial pain/persistent idiopathic facial pain
Recruited patients (53 males; mean age 33.9 years ± 7.5 SD) suffering from atypical facial pain affecting the area of the eyes, were previously treated with all the substances commonly used in such a pain, namely tricyclics, negative modulators of excitatory aminoacids, selective serotonin reuptake inhibitors and norepinephrine reuptake inhibitors given as 3-month treatments and narcotics given as hospital short-lasting (5 days) regimen
Conclusions a) When a disease is rare it does not mean it can be neglected; b) an inherited abnormality of the central nervous system, namely inheritable hyperalgesia pattern seemingly provokes a redundancy of painful expression that may lead to diagnostic mistakes
Summary
It is not so infrequent that a patient reports severe pain with a clear focus in/around the eye that looks like an atypical facial pain/persistent idiopathic facial pain. Aim To evidence possible causes of therapeutic mistakes in persistent facial pain, affecting the eye area. Materials and methods Observation started 26 years ago.
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