Abstract
Patients：A 74-year-old female has suffered from bilateral upper molar dull pain and temporal headache since 5 years ago．She visited a nearby dental clinic, but no abnormalities were pointed out in the upper jaw. A few months before visiting our hospital, she suddenly noticed dizziness and nausea during dinner, and visited a hospital emergency department. She was diagnosed with Meniere’s disease and dizziness and nausea disappeared. Left temporal headache and left upper molar pain became worse, she was referred to the Department of Pain Clinic in our hospital due to the unexplained paroxysmal orofacial pain. One month after the first consultation, MRI was performed because the paroxysmal pain aggravated. Head MRI showed a space-occupying lesion in the left posterior fossa region. We have referred her to a neurosurgeon. Open surgery of the posterior fossa was performed under general anesthesia. The pain in the left upper molars and temples disappeared. The patient has been followed up without any sequela.
Discussion：The case was diagnosed as chronic headache associated with secondary trigeminal neuralgia due to a giant meningioma in the posterior cranial fossa. Although benign tumors may develop slowly and patients may not present with typical neurologic signs, they sometimes complain of chronic orofacial pain and headaches with neuralgiform symptoms. Dentists should be aware of brain hypertonic signs and should not hesitate to employ screening tests.
Conclusions：If chronic headaches or cranial nerve symptoms are present, dentists should differentially diagnose orofacial pain from secondary headaches or secondary trigeminal neuralgia attributed to intracranial lesions and MRI may be essential to diagnose them.
