Fourteen year retrospective study of craniofacial pain in a neurological emergency department

Abstract

This fourteen-year retrospective cross-sectional study (August 2010 - July 2024) provides the first analysis of neuropathic craniofacial pain (CFP) in a neurological emergency department (ED), evaluating its types, characteristics, and management. Data from electronic medical records were analyzed using descriptive statistics and non-parametric tests (p < 0.05). Among 156 adult CFP patients (median age 61 years; female 108/156, 69.2%), six CFP types were identified, with trigeminal neuralgia (TN) being the most common (122/156, 78.2%), and etiologically defined in 30/122 patients (24.6%). The typical patient was an elderly female with severe, right-sided TN affecting the V2 and V3 branches. Acute treatment lacked guideline-supported rapid-onset options, relying instead on nonopioid and opioid analgesics (48/54 patients, 88.9%). There was a decline in cases after the beginning of the COVID-19 pandemic (p = 0.001). Rare CFPs and their combinations can initially present in the ED, where diagnostic complexity and treatment gaps pose significant challenges. These findings highlight the ED's critical role and the need for institutional guidelines based on ICHD-3 or ICOP to improve CFP management.