Editorial

Unraveling the challenge of head and facepain

The differential diagnosis and treatment of headache

and craniofacial pain has long been a subject of

debate. Historically, much has been written on the

topic, extending back into ancient times,1 yet the

clinical decision making process with these patients

remains challenging.2,3 A 2007 study suggested that

the percentage of the global adult population with an

active headache disorder was as high as 46%.2

Although reportedly less prevalent, orofacial pain,

including tempromandibular joint pain, has a sub-

stantial negative impact on patients who suffer with

it.3 Accordingly, the International Association for the

Study of Pain (IASP) has recently launched the 2013–

2014 Global Year Against Orofacial Pain campaign,

highlighting the fact that this common form of pain is

often poorly recognized and inadequately treated.

To launch this special issue on headache and

craniofacial pain, we present a two part series by

Shaffer and colleagues4,5 which discusses the evalua-

tion and physical therapy management of tempro-

mandibular (TMD) dysfunction. These papers draw

from an expanding research literature, and provide

an evidence-based review of the biomechanical and

clinical features of TMD, as well as valuable guide-

lines for management. von Piekartz and Mohr6

discuss the unique neurophysiological effects of facial

pain. Importantly, this work highlights how facial

pain may impede the ability to express emotions, and

as a consequence, the ability to perceive emotions in

others. This altered affective state, i.e., the inability to

express and recognize emotions, painful or otherwise,

may predispose the individual to chronic pain.7 This

may be a paradigm shift for some clinicians;

specifically, that dysfunction in affect may be both

a cause and effect of chronic pain.

While recent interest has focused on the cognitive

sequellae of traumatic brain injury, Defrin8 draws

attention to a major adverse outcome that may occur

following brain trauma: post-concussive headache.

An incredibly high number of individuals experience

chronic headache following traumatic head injury.9

Both the contributions by Defrin,8 as well as

Fernandez-de-las-Penas and Courtney10 address the

complex pathophysiology and the importance of

multimodal treatment plans for individuals with

headache. This complexity is demonstrated by Stuhr

and colleagues,11 who describe a successful outcome

in a young patient with both headache and TMD

complaints.

As guest editors, we postulate that the topic of

headache and craniofacial pain is likely under-

addressed in many professional and post-graduate

education programs. If this is the case, we

challenge educators, clinicians, and researchers to

turn their attention to this group of chronic pain

conditions, which affects such a large proportion of

our society.

Carol A. Courtney and Cesar Fernandez-de-las-

Penas

References1 Eadie MJ. Headache through the centuries. New York, NY:

Oxford University Press, 2012.2 Stovner LJ, Hagen K, Jensen R, Katsarava Z, Lipton R, AI

Scher, TJ Steiner, J-A Zwart. The global burden of headache: adocumentation of headache prevalence and disability world-wide. Cephalalgia. 2007;27:193–210.

3 Slade GD, Smith SB, Zaykin DV, Tchivileva IE, Gibson DG,Yuryev A, Mazo I, Bair E, Fillingim R, Ohrbach R, GreenspanJ, Maixner W, Diatchenko L. Facial pain with localized andwidespread manifestations: Separate pathways of vulnerability.Pain. 2013;154:2335–2343.

4 Shaffer SM, Brismee JM, Sizer PS, Courtney CA.Temporomandibular disorders. Part 1: anatomy and examina-tion/diagnosis. J Man Manip Ther. 2014;22:2–12.

5 Shaffer SM, Brismee JM, Sizer PS, Courtney CA. Temporo-mandibular disorders. Part 2: Conservative Management. J ManManip Ther. 2014;22:13–23.

6 Von Piekartz H and Mohr G. Reduction of head and face painby challenging lateralization and basic emotions: a proposal forfuture assessment and rehabilitation strategies. J Man ManipTher. 2014;22:24–35.

7 Mailhot JP, Vachon-Presseau E, Jackson PL, Rainville P.Dispositional empathy modulates vicarious effects of dynamicpain expressions on spinal nociception, facial responses andacute pain. Euro J Neurosci. 2012;35:271–278.

8 Defrin R. Chronic post traumatic headache: clinical findingsand possible mechanisms. J Man Manip Ther. 2014;22:36–44.

9 Lahz S, Bryant RA. Incidence of chronic pain followingtraumatic brain injury. Arch Phys Med Rehab. 1996;77:889–891.

10 Fernandez-de-las-Penas C and Courtney CA. Clinical reason-ing for manual therapy management of tension type andcervicogenic headache. J Man Manip Ther. 2014;22:45–51.

11 Stuhr SH, Earnshaw DH, Duncombe AM. Use of orthopedicmanual physical therapy to manage chronic orofacial pain andtension type headache in an adolescent. J Man Manip Ther.2014;22:52–59.

� W. S. Maney & Son Ltd 2014DOI 10.1179/1066981713Z.00000000090 Journal of Manual and Manipulative Therapy 2014 VOL. 22 NO. 1 1