11.9 Headache or facial pain attributed to other disorder of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cervical structure

Identification: Male patient, 56 years old, presenting with right orbital pain for 2 months.

History of Present Illness: Pain:

Location: Root of the nose and right medial orbital corner

Characteristic: Paroxysmal (1-2 seconds), stabbing, severe intensity (9/10)

Triggers: Touching the nasal ala or extreme eye movement

Associated symptoms:

Ipsilateral watery rhinorrhea during attacks

Episodic conjunctival hyperemia

Transient unilateral photophobia

Relevant history:

Endoscopic sinus surgery 5 years ago

No recent facial trauma

Physical Examination:
Cranial Neurological:

Hyperesthesia in the distribution of the nasociliary nerve (C2 dermatomal area)

Positive Charlin's sign (pain relief after topical anesthetic in the middle nasal meatus)

Ophthalmological:

Slight edema of the lacrimal caruncle

Normal Schirmer test

ENT:

Unilateral hyperemic nasal mucosa

No structural changes on nasofibroscopy

Complementary Exams:
Craniofacial Magnetic Resonance Imaging:

Nasociliary nerve pathway without vascular compression

Post-surgical signs in the anterior ethmoidal sinus

Diagnostic Anesthetic Block:

Infiltration of 2% lidocaine in the anterior ethmoidal nerve → immediate resolution of pain for 8 hours