Treatment of cranio-facial pain with radiofrequency procedures.

Chronic pain conditions arising in the head, face, or neck have been traditionally a confusing area with a lack of a universally accepted classification. Despite the little progress in the understanding of the pathophysiologic processes in the origin of cranio-facial pain, new drugs and surgical procedures have improved the treatment. When the pain is limited to the distribution of a specific cranial nerve or its branch (the trigeminal, facial, glossopharyngeal and vagus), the term “typical neuralgia” is used, being the “classic or major trigeminal neuralgia, the most common.” The term “atypical neuralgia” labels a group of facial pain conditions where the pain is not limited to a cranial nerve distribution and the borders of the various clinical conditions are not precise. The diagnosis of a head or cranio-facial pain requires a comprehensive medical history and physical examination of the patient. The pain characteristics—location, sensorial features, severity or intensity—associated factors that aggravate or relive it and accompanying signs: sensory changes— hyper or hypoalgesia—motor disturbances and autonomic dysfunction—hyperhidrosis, lacrimation—or any other nervous system dysfunction, must be assessed and registered in detail by the clinician. The examination of the patient must include the inspection of every external part of the head as well as the facial expression and position of the head. Palpation must be oriented to determine trigger points, tenderness areas, tumors or tumefaction. The cervical area, including the muscles of the neck must be examined as it can be closely related to certain cranio-facial or head pain conditions, and a careful evaluation of the cranial nerves, the upper 3 cervical nerves and sympathetic innervation of the head is mandatory. 1