Differentials
Dental caries
SIGNS / SYMPTOMS
Well localized to a single tooth.
INVESTIGATIONS
Intraoral radiographs.
Dental fracture
SIGNS / SYMPTOMS
Localized to ≥1 teeth; may be provoked by biting.
INVESTIGATIONS
Intraoral radiographs.
Mandibular osteomyelitis
SIGNS / SYMPTOMS
Typically continuous pain along mandible with associated swelling. History of fever, malaise, purulent discharge, mobile teeth.
INVESTIGATIONS
Intraoral radiographs.
Temporomandibular joint syndrome
SIGNS / SYMPTOMS
Often bilateral, jaw opening may be restricted.
INVESTIGATIONS
No differentiating tests.
Migraine
SIGNS / SYMPTOMS
Presence of preceding aura. Associated with photophobia, nausea.
INVESTIGATIONS
No differentiating tests.
Glossopharyngeal neuralgia
SIGNS / SYMPTOMS
Pain is in the distribution of the glossopharyngeal nerve, classically oropharyngeal and otic.
INVESTIGATIONS
No differentiating tests.
Postherpetic neuralgia
SIGNS / SYMPTOMS
Typically presents as continuous pain in distribution of upper division of trigeminal nerve (V1). Patient often has tactile allodynia.
INVESTIGATIONS
No differentiating tests.
Temporal arteritis
SIGNS / SYMPTOMS
Pain is often continuous, can be bilateral, and may be associated with jaw claudication, visual changes, and anorexia.
INVESTIGATIONS
Erythrocyte sedimentation rate, temporal artery biopsy.
Atypical facial pain
SIGNS / SYMPTOMS
Often is bilateral and/or exceeds the confines of a trigeminal distribution.
INVESTIGATIONS
Diagnosis is made with formal neuropsychologic evaluation.
Trigeminal autonomic cephalgias (e.g., cluster headache, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing [SUNCT] syndrome, chronic paroxysmal hemicrania)
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