Abstract
Orofacial Pain （OFP） involves dental and medical disorders. OFP disorders range from odontogenic pain, to neurovascular pain such as migraine and cluster headache, musculoskeletal pain such as temporomandibular disorders, neurogenic pain including neuralgias and neuropathies, and pain associated with psychogenic disorders, and the majority of these medical diseases are neurological headache diseases. To diagnose neurological disorders, neurologists perform a proper assessment of patients including history taking and neurological examination, and laboratory and radiological studies. OFP specialists must gain basic methods of neurological diagnosis and current knowledge of the basic and clinical science of major headache disorders, such as migraine, cluster headache and medication overuse headache. Pathophysiological changes of trigeminal nerves and central nervous system are found in patients with migraine and cluster headache. Functional imaging study reveals central sensitization, dysfunction of pain control systems, and pain matrix changes. Chronic pain should be considered a brain disease in which alterations in neural networks affect multiple aspects of brain function, structure and chemistry. Medication overuse headache is associated with reversible functional changes in pain processing structures, but also with persistent orbitofrontal hypofunction after treatment. Pathophysiological changes of central nervous system and persistent hypofunction may occur in chronic OFP. OFP specialists should consider to these pathophysiological changes when to treat patients with intractable OFP. The best way to gain a current medical knowledge of headache disorders for OPF specialists is to join the Japanese Headache Society.
