Abstract
Patients: A 50-year old female complained of pain on the left lateral temporal area and left-upper posterior teeth. The dentist diagnosed atypical odontalgia, and she received drug therapy. But the symptom did not change and she was referred to our pain clinic. The clinical examination and panoramic radiograph revealed no obvious problems and pathological tissue alterations. According to the criteria of the International Classification of Headache Disorders, 3rd edition ; beta version, we suspected migraine without aura and neurovascular orofacial pain associated to it. In addition, she had tension-type headache and panic disorder as her past medical history. So we referred her to a physician and a psychiatrist, and managed the patient together with them. Based on the diagnosis of tension-type headache, migraine without aura and anxiety disorder, psychotherapy and kampo medicine relieved her pain and associated symptoms.
Discussion: This patient is classified into the type C of MW classification（both psychic symptoms and somatic diseases are present）. For such a case, we need multimodal management including psychological supports by psychiatrists. We managed this patient by psychotherapy and kampo medicine which could be effective for the management of pain accompanied with a variety of associated symptoms.
Conclusion: For patients with complicated orofacial conditions, both physiological and psychological problems should be taken into account, and also be managed in multidisciplinary approaches in a liaison system.
