This publication discusses the details and differences between chronic tension type headache and migraine and followed a cohort of 240 patients over 36 months. The authors applied strict criteria to distinguish between chronic tension headache and migraine, these essentially being that in the former, the pain lasted for hours not days, the pain was bilateral and photophobia, nausea and vomiting were much less prevalent than in migraine. It was noted that patients suffering from facial pain had no difference in BMI but were better educated and in more professional occupations. Strict inclusion and exclusion criteria were applied. Patients who had past sinus surgery, baro-trauma, trauma, TMJ dysfunction, were pregnant, had a history of drug usage for depression or use of solvents and alcohol were excluded. Patients with positive sinus CT findings were also excluded. In the three-year follow-up, it was observed that 45.5% of patients with chronic tension headache who received regular amitriptyline for eight weeks reported resolution (less than one episode per month) whereas only 23% of those with migraine, treated with 10mg amitriptyline or propanolol, achieved the same. Patients on regular medication did better than ones taking NSAID for chronic tension headache and triptans for migraine as and when required. Interestingly, pain was reported as bilateral in 48% of patients with migraine, in contrast to the general belief that it is unilateral. The incidence of rhinitis, positive skin tests, cigarette smoke and exposure to systemic illnesses was similar in patients with mid-facial pain and migraine in comparison with the general Maltese population; this is in contrast to a previous Norwegian study. This is an elaborate study that highlights symptomatology and presentation of facial pain common to otolaryngology clinics.
Chronic facial pain: types and long-term treatment
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