Hemicrania paroxística com apresentações na face e disfunção temporomandibular associada: relato de caso.

Abstract

Paroxysmal Hemicrania (PH) is a trigeminal autonomic cephalalgia described as a severe and strictly unilateral pain, which occurs in paroxysms at orbital, supraorbital and temporal region, or in combination of these sites. It may have representations in the face and be coexistent with other conditions, such as Temporomandibular Disorders (TMD), leading to the possibility of misdiagnosis. A 45-year-old woman presented to an Orofacial pain specialist presenting recurrent severe, burning, throbbing, strictly right-sided headache associated to ipsilateral autonomic symptoms and orofacial pain. During attacks, the pain was perceived on the maxillary region followed by pain spread to the head. Interdisciplinary evaluation (dentist and neurologist), along with absolute responsiveness to indomethacin and normal Brain Magnetic Resonance imaging led to the diagnosis of primary Episodic PH with facial representation and ipsilateral myofascial pain of masticatory muscles enabling a proper management of both conditions. Dentists should be aware of PH with facial representation and the possibility of TMD coexistence in order to avoid misdiagnosis and inadequate management. PH may be first perceived on the face and may be associated with interparoxysmal pain. In these cases, efficient anamnesis and clinical evaluation followed by an interdisciplinary approach is needed.