Imaging Approach for the Diagnosis of Head and Face Pain

  • Ryan T. Fitzgerald
  • Vikas Agarwal


Facial and head pain can be a feature of a wide array of disease entities across several medical domains. Time course and periodicity of pain, location, quality, and comorbidities are just a few of the factors that allow formation of a differential diagnosis. In many cases, diagnosis and management of pain symptomatology can be accomplished on a clinical basis that does not require imaging. In other instances, imaging plays a crucial role in diagnosis and treatment planning. For this chapter, we focus attention on disease entities in which imaging is a key component of the workup and/or management of pain, namely, some forms of headache and trigeminal pain. Other entities that may cause facial pain, such as pain of dental origin, will be thoroughly covered in a separate section. In each section, our goal is to discuss the indications for imaging, preferred modalities and techniques, and impact of imaging on management and/or treatment.


Headache Trigeminal neuralgia Glossopharyngeal neuralgia Magnetic resonance imaging Computed tomography Diagnostic imaging Neuroimaging Guidelines Vascular compression 


  1. 1.
    Kuruvilla DE, Lipton RB. Appropriate use of neuroimaging in headache. Curr Pain Headache Rep. 2015;19(6):17.CrossRefPubMedGoogle Scholar
  2. 2.
    May A. New insights into headache: an update on functional and structural imaging findings. Nat Rev Neurol. 2009;5(4):199–209.CrossRefPubMedGoogle Scholar
  3. 3.
    Douglas A, et al.. American College of Radiology ACR Appropriateness Criteria® Headache. Available at: Accessed 4 April 2017.
  4. 4.
    Siccoli MM, Bassetti CL, Sándor PS. Facial pain: clinical differential diagnosis. Lancet Neurol. 2006;5(3):257–67.CrossRefPubMedGoogle Scholar
  5. 5.
    Dandy WE. Concerning the cause of trigeminal neuralgia. Am J Surg. 1934;24(2):447–55.CrossRefGoogle Scholar
  6. 6.
    Haller S, et al. Imaging of neurovascular compression syndromes: trigeminal neuralgia, hemifacial spasm, vestibular paroxysmia, and glossopharyngeal neuralgia. Am J Neuroradiol. 2016;37(8):1384–92.CrossRefPubMedGoogle Scholar
  7. 7.
    Hughes MA, et al. MRI of the trigeminal nerve in patients with trigeminal neuralgia secondary to vascular compression. Am J Roentgenol. 2016;206(3):595–600.CrossRefGoogle Scholar
  8. 8.
    Sindou M, Howeidy T, Acevedo G. Anatomical observations during microvascular decompression for idiopathic trigeminal neuralgia. Acta Neurochir (Wien). 2002;144(1):1–12.CrossRefGoogle Scholar
  9. 9.
    Leal PRL, et al. Visualization of vascular compression of the trigeminal nerve with high-resolution 3T MRI: a prospective study comparing preoperative imaging analysis to surgical findings in 40 consecutive patients who underwent microvascular decompression for trigeminal neuralgia. Neurosurgery. 2011;69(1):15–25, discussion 26.CrossRefPubMedGoogle Scholar
  10. 10.
    Sindou M, et al. Microvascular decompression for primary trigeminal neuralgia: long-term effectiveness and prognostic factors in a series of 362 consecutive patients with clear-cut neurovascular conflicts who underwent pure decompression. J Neurosurg. 2007;107(6):1144–53.CrossRefPubMedGoogle Scholar
  11. 11.
    Régis J, et al. Prospective controlled trial of gamma knife surgery for essential trigeminal neuralgia. J Neurosurg. 2006;104(6):913–24.CrossRefPubMedGoogle Scholar
  12. 12.
    Régis J, et al. Long-term safety and efficacy of Gamma Knife surgery in classical trigeminal neuralgia: a 497-patient historical cohort study. J Neurosurg. 2016;124(4):1079–87.CrossRefPubMedGoogle Scholar
  13. 13.
    Hughes MA, et al. MRI findings in patients with a history of failed prior microvascular decompression for hemifacial spasm: how to image and where to look. Am J Neuroradiol. 2015;36(4):768–73.CrossRefPubMedGoogle Scholar
  14. 14.
    Hiwatashi A, et al. MRI of glossopharyngeal neuralgia caused by neurovascular compression. Am J Roentgenol. 2008;191(2):578–81.CrossRefGoogle Scholar
  15. 15.
    Sampson JH, et al. Microvascular decompression for glossopharyngeal neuralgia: long-term effectiveness and complication avoidance. Neurosurgery. 2004;54(4):884–90.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Ryan T. Fitzgerald
    • 1
  • Vikas Agarwal
    • 2
  1. 1.Department of RadiologyUniversity of Arkansas for Medical SciencesLittle RockUSA
  2. 2.Department of RadiologyUniversity of Pittsburgh Medical CenterPittsburghUSA

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