ABSTRACT In this article, the anatomic and physiologic characteristics and clinical syndromes involving the auriculotemporal nerve (ATN) are reviewed. The ATN is a terminal branch of the mandibular nerve (third division of the trigeminal nerve). The syndrome of ATN neuralgia (ATNa), which is characterized by attacks of paroxysmal, moderate to severe pain on the preauricular area, often spreading to the ipsilateral temple, is discussed in this article. The classification of ATNa under the Second Edition of the International Classification of Headache Disorders, as well as our personal experience in diagnosing and treating this syndrome, also are reviewed.
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ABSTRACT: The neuralgias are characterized by pain in the distribution of a cranial or cervical nerve. While most often brief, severe, and paroxysmal, continuous neuropathic pain may occur. The most commonly encountered entities include trigeminal, postherpetic, glossopharyngeal, and occipital neuralgia. More unusual cranial neuralgias may occur in periorbital (eg, supraorbital neuralgia) and auricular (eg, nervus intermedius neuralgia) distributions. These disorders may be mimicked by structural and inflammatory/infectious neurologic disease, along with other primary headache disorders (eg, primary stabbing headache). The approach to diagnosis and treatment of this group of headache disorders is reviewed.Current Neurology and Neuroscience Reports 07/2014; 14(7):459. · 3.78 Impact Factor
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ABSTRACT: OBJECTIVE: To describe a standardized methodology for the performance of peripheral nerve blocks (PNBs) in the treatment of headache disorders. BACKGROUND: PNBs have long been employed in the management of headache disorders, but a wide variety of techniques are utilized in literature reports and clinical practice. METHODS: The American Headache Society Special Interest Section for PNBs and other Interventional Procedures convened meetings during 2010-2011 featuring formal discussions and agreements about the procedural details for occipital and trigeminal PNBs. A subcommittee then generated a narrative review detailing the methodology. RESULTS: PNB indications may include select primary headache disorders, secondary headache disorders, and cranial neuralgias. Special procedural considerations may be necessary in certain patient populations, including pregnancy, the elderly, anesthetic allergy, prior vasovagal attacks, an open skull defect, antiplatelet/anticoagulant use, and cosmetic concerns. PNBs described include greater occipital, lesser occipital, supratrochlear, supraorbital, and auriculotemporal injections. Technical success of the PNB should result in cutaneous anesthesia. Targeted clinical outcomes depend on the indication, and include relief of an acute headache attack, terminating a headache cycle, and transitioning out of a medication-overuse pattern. Reinjection frequency is variable, depending on the indications and agents used, and the addition of corticosteroids may be most appropriate when treating cluster headache. CONCLUSIONS: These recommendations from the American Headache Society Special Interest Section for PNBs and other Interventional Procedures members for PNB methodology in headache disorder treatment are derived from the available literature and expert consensus. With the exception of cluster headache, there is a paucity of evidence, and further research may result in the revision of these recommendations to improve the outcome and safety of these interventions.Headache The Journal of Head and Face Pain 02/2013; · 2.94 Impact Factor
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ABSTRACT: Synovial cysts of the temporomandibular joint are rare, and to our knowledge, only 14 cases have been reported. The most common presentation is local pain and swelling. We present a case of a synovial cyst presenting with neuralgia in the distribution of the auriculotemporal nerve, initially misdiagnosed as trigeminal neuralgia.Headache The Journal of Head and Face Pain 09/2013; · 2.94 Impact Factor