Neurovascular Orofacial Pain

Referral of pain to facial and oral structures is common in neurovascular craniofacial pain (NVCP). Pain quality in NVCP often resembles dental pathologies so dental practitioners often encounter these patients. The commonest NVCPs, migraines and trigeminal autonomic cephalgias (TACs), are classically located around the ocular and frontal regions. Yet, isolated primary neurovascular-type pain in the lower two thirds of the face has been reported. These patients are not easily classified and have been termed facial migraine, or lower-half migraine. Often these isolated facial pains present with a clinical phenotype that, other than the location, may be diagnosed as a migraine or TAC variant. However, a primary facial neurovascular pain possibly separate from migraines or TACs may exist, called “neurovascular orofacial pain” (NVOP). These diagnostic entities are of high importance in the differential diagnosis of oral and facial pain and will avoid misdiagnoses as sinusitis and/or dental pulpal pathology. In addition to the location outside the conventional boundaries of migraine and TACs, NVOP presents with a distinctive combination of clinical signs and symptoms. Thus, the rationale for introducing NVOP is based on specific features that segregate it from other primary neurovascular-type craniofacial pain. Due to its intraoral and perioral location NVOP has great diagnostic and therapeutic importance in differentiating it from dental pathology. A clear classification and terminology will avoid misdiagnosis and dental mutilation. A brief description of NVCP and its underlying pathophysiology is introduced to give a framework for a better understanding of NVOP.