Orofacial trigeminal autonomic cephalalgias: A review of case reports

Objective: To describe the characteristics of trigeminal autonomic cephalalgias (TAC) presenting as orofacial pain. Methods: A web search was performed on various databases to find relevant case reports or series reporting TAC presenting in V2 and/or V3 of the trigeminal ‎nerve distribution. Headaches were classified according to the International Classification of Headache Disorders III and the International Classification of Orofacial Pain. Descriptive analyses were employed, and multivariable linear regression models assessed the factors associated with (i) longer time since the onset of TAC and (ii) a higher number of previous providers‎ at the time of report. Results: Intraoral/tooth pain was reported by 47% (n = 34) of cases, with 11 without headache or V1 involvement. Cases had an average of 2.2 autonomic symptoms ‎‎(standard deviation (SD) = 1.3), 4.5 years since onset (SD = 5.3), and 2.6 previous ‎providers (SD = 1.5) at the time of the report. Autonomic symptoms increased as the time since pain onset (n = 50, β = 1.30, p =.026) and age (β = 0.13, p =.032) ‎increased when adjusted for sex and the trigeminal distribution of involvement. The number of previous providers tended to be lower for TAC with shorter episodes (β = -1.48, SD = 0.47, p =.004) than for TAC with long attacks or continuous pain. Conclusion: Orofacial TAC present a diagnostic challenge for clinicians. Multidisciplinary care and more education are recommended. Further research is needed to properly understand them.