Editorial

Unraveling the challenge of head and face

pain
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 substantial 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 evaluation and physical therapy management of tempromandibular (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 guidelines 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

W. S. Maney & Son Ltd 2014

DOI 10.1179/1066981713Z.00000000090

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 underaddressed 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-lasPenas

References
1 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: a
documentation of headache prevalence and disability worldwide. Cephalalgia. 2007;27:193210.
3 Slade GD, Smith SB, Zaykin DV, Tchivileva IE, Gibson DG,
Yuryev A, Mazo I, Bair E, Fillingim R, Ohrbach R, Greenspan
J, Maixner W, Diatchenko L. Facial pain with localized and
widespread manifestations: Separate pathways of vulnerability.
Pain. 2013;154:23352343.
4 Shaffer SM, Brismee JM, Sizer PS, Courtney CA.
Temporomandibular disorders. Part 1: anatomy and examination/diagnosis. J Man Manip Ther. 2014;22:212.
5 Shaffer SM, Brismee JM, Sizer PS, Courtney CA. Temporomandibular disorders. Part 2: Conservative Management. J Man
Manip Ther. 2014;22:1323.
6 Von Piekartz H and Mohr G. Reduction of head and face pain
by challenging lateralization and basic emotions: a proposal for
future assessment and rehabilitation strategies. J Man Manip
Ther. 2014;22:2435.
7 Mailhot JP, Vachon-Presseau E, Jackson PL, Rainville P.
Dispositional empathy modulates vicarious effects of dynamic
pain expressions on spinal nociception, facial responses and
acute pain. Euro J Neurosci. 2012;35:271278.
8 Defrin R. Chronic post traumatic headache: clinical findings
and possible mechanisms. J Man Manip Ther. 2014;22:3644.
9 Lahz S, Bryant RA. Incidence of chronic pain following
traumatic brain injury. Arch Phys Med Rehab. 1996;77:889
891.
10 Fernandez-de-las-Penas C and Courtney CA. Clinical reasoning for manual therapy management of tension type and
cervicogenic headache. J Man Manip Ther. 2014;22:4551.
11 Stuhr SH, Earnshaw DH, Duncombe AM. Use of orthopedic
manual physical therapy to manage chronic orofacial pain and
tension type headache in an adolescent. J Man Manip Ther.
2014;22:5259.

Journal of Manual and Manipulative Therapy

2014

VOL .

22

NO .