Diagnosis and Management of Traumatically Induced Hemicrania Continua and Neuropathic Pain Secondary to Facial Gun Shot Wound.

There are few cases of traumatically induced trigeminal autonomic cephalgia (TAC) reported in the literature, and few if any related specifically to hemicrania continua (HC). This case report describes a patient with HC with concomitant painful post traumatic trigeminal neuropathy (PPTTN) of the second division of the trigeminal nerve (CN-V2), and partial facial nerve paralysis secondary to a gunshot wound to the face. The patient reported no history of HC or neuropathic pain prior to the assault and felt that these conditions were sequela of his injuries and not the surgical procedures as they evolved during the following year and not immediately post operatively. The specific complaints were not reported until referred for a comprehensive orofacial pain evaluation for rehabilitation of mandibular range of movement, and not considered secondary to the surgery, but due to the trauma. This 53-year-old male sustained significant trauma as the trajectory of the projectile destroyed the maxillary anterior teeth, palate and left temporomandibular joint (TMJ). (Illustrations 1) While subsequent facial nerve palsy and PPTTN were plausible, considering the trajectory of the bullet, periorbital pain associated with autonomic features was not. The patient underwent comprehensive surgical treatment to repair the traumatic injuries. However, pain management required a viable diagnoses and effective treatment.