Facial pain in multiple sclerosis is often due to trigeminal neuralgia but atypical pictures can be observed.
Case presentation:
A man with primary progressive multiple sclerosis developed severe unilateral facial pain in the right orbital region. Spontaneous and triggered attacks were associated with ipsilateral conjunctival injection and lacrimation. A diagnosis of short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing was made, and symptoms significantly improved with lamotrigine.
Conclusion:
Pain is poorly investigated in multiple sclerosis, with a dramatic impact on patients’ life quality. In this light, standardized evaluation of pain is needed to improve patient management.
Di StefanoGDe StefanoGDi LionardoA, et al. Pharmacotherapeutic options for managing pain in multiple sclerosis. CNS Drugs2020; 34(7): 749–761.
2.
Di StefanoGMaarbjergSTruiniA. Trigeminal neuralgia secondary to multiple sclerosis: From the clinical picture to the treatment options. J Headache Pain2019; 20(1): 20.
3.
Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia2018; 38(1): 1–211.
4.
VilisaarJConstantinescuCS. SUNCT in multiple sclerosis. Cephalalgia2006; 26(7): 891–893.
5.
GrecaLAMenegattiRSGonçalvesMVM. SUNCT in a patient with multiple sclerosis: A case report. Headache2017; 57(9): 1431–1432.
6.
LambruGRantellKO’ConnorE, et al. Trigeminal neurovascular contact in SUNCT and SUNA: A cross-sectional magnetic resonance study. Brain2020; 143(12): 3619–3628.
7.
LambruGStubberudARantellK, et al. Medical treatment of SUNCT and SUNA: A prospective open-label study including single-arm meta-analysis. J Neurol Neurosurg Psychiatry2021; 92(3): 233–241.
8.
LambruGLagrataSLevyA, et al. Trigeminal microvascular decompression for short-lasting unilateral neuralgiform headache attacks. Brain2022; 145(8): 2882–2893.
