Migraine with isolated facial pain: a diagnostic challenge


Mark Obermann, MD, Department of Neurology, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany. Tel. + 49 201 7238 4385, fax + 49 201 723 3789. e-mail mark.obermann@uni-due.de


We present a series of seven migraine patients with typical features of a migraine attack without aura, but atypical pain localization in the face in one or both of the lower two distributions of the trigeminal nerve (V2 and V3). All of them responded well to triptans. Three patients responded to preventive treatment for migraine with β-blockers (n = 2) or valproic acid (n = 1). These cases underline the heterogenic clinical presentation of migraine, which is sometimes difficult to diagnose even for headache specialists, and broaden the pathophysiological understanding of trigeminal nociceptive processing in migraine in the light of neuronal plasticity.