Abstract
Patient: A 37-year-old man experienced severe pain at the maxillary left second molar and orbital area. First, he visited an ophthalmology clinic ; however, his pain did not alleviate. Second, he visited a nearby dental clinic, where he was prescribed clarithromycin and loxoprofen sodium ; however, his symptom did not improve. Dental caries was detected and removed. However, the pulsating severe pain over the tooth and temporal region still occurred more than 5 times per day, and this symptom was accompanied by conjunctival hyperemia and nasal discharge. When the symptoms occurred, the patient exhibited restlessness in the clinic. Since, we first diagnosed his condition as cluster headache, oxygen was administered, following which the pain decreased. Subsequently, we consulted the physician at our hospital and the patient was prescribed sumatriptan succinate 100mg. However, the patient presented to us again after the symptoms recurred. At this time, we suspected paroxysmal hemicrania（PH） and prescribed indomethacin 50mg. The symptoms of toothache and headache alleviated. There has been no recurrence of pain since then.
Discussion: In total, 15％ of patients who develop PH experience toothache, and they often visit a dental clinic with paroxysmal toothache and facial pain. In this case, the patient presented with a chief complaint of toothache ; however, the cause of toothache was thought to be PH.
Conclusion: We believe that dentists should have adequate knowledge of headaches, because patients often visit the dentistry department with neurovascular toothache.
