Zusammenfassung
Der atypische Gesichtsschmerz gilt als Sammelbe-griff für anderweitig nicht klassifizierbare Schmerzsyndrome im Gesicht. Er beschreibt tägliche, über-wiegend einseitige, konstante, in der Intensität fluktuierende, ziehende und brennende Schmerzen, die über Jahre hinaus bestehen können und oft von Dys-bzw. Parästhesien begleitet sind. Frauen sind häufiger betroffen. Bemerkenswert ist die hohe Zahl invasiver Eingriffe vor der end-gültigen Diagnosestellung. Psychopathologische Auffälligkeiten sind häufig, bestehen aber nicht nur aus “larvierten” Depressionen. Die Frage einer optimalen Therapie des atypischen Gesichtsschmerzes ist ungelöst. Am häufigsten werden trizyklische Antidepressiva wie Amitriptylin oder Imipramin bzw. MAO-Hemmer oder Antikonvulsiva, wie Carbamazepin und Phenytoin eingesetzt. Keine Behandlung führt zur Heilung des atypischen Gesichts-schmerzes. Dies gilt auch für verhaltenstherapeutische Maßnahmen, die im Vordergrund der Therapie stehen sollten. Jede operative Intervention ist zu vermeiden. Differentialdia-gnostisch muß der atypische Gesichtsschmerz vom zervikogenen Kopfschmerz bzw. vom Cluster-Kopfschmerz abgegrenzt werden; darüber hinaus sollten intrakranielle Tumoren des N. trigeminus oder des Kleinhirnbrückenwinkels, bzw. erosive Tumoren der Schädelbasis, der Orbita oder des Naso-pharynx ausgeschlossen werden.
Abstract
Atypical facial pain is a collective term used for otherwise unclassifiable pain syndromes of the face. It describes mostly unilateral lancinating and burning pain, which is constantly present but fluctuating in intensity and may be accompanied by dys-or paraesthesias over a period of several years. Women are more often affected than men. A strikingly large number of invasive investigative procedures are performed before the final diagnosis is established. Psychopathological abnormalities are frequent and do not consist solely in masked depression. To date there is no cure for atypical facial pain. Most frequently tricyclic antidepressants such as amitriptyline and imipramine, MAO inhibitors or anticonvulsives such as carbamazepine and phenytoin are used, which only alleviate the pain. This also holds true for behaviour therapy, which should be the first-line treatment. Any invasive intervention should be avoided. In the differential diagnosis atypical facial pain should be distinguished from cervicogenic or cluster headache, and also from intracranial tumours of the trigeminal nerve or the cerebellar-pontine angle, erosive tumors of the base of the skull, orbitas and nasopharynx.
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Pfaffenrath, V., Dieterich, M. Diagnostik und Therapie des atypischen Gesichtsschmerzes—eine Übersicht. Schmerz 9, 235–241 (1995). https://doi.org/10.1007/BF02529444
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DOI: https://doi.org/10.1007/BF02529444