Oral and Craniofacial Pain: Contribution of Endogenous, Central Modulation Mechanisms

In this chapter, we will describe the main endogenous, central modulation and related maladaptive mechanisms involved in processing oral and craniofacial pain. In particular, we will explain how the functional anatomy and pathophysiology of brainstem, hypothalamic, and corticofugal networks may alter the excitability of the trigeminal system. We will describe our recent findings showing a direct anatomo-functional relationship between cortical, hypothalamic excitability disturbances and dysfunctions of medullary trigeminovascular regions. We will analyze the impact of such dysfunctions as putative biomarkers of central sensitization phenomena at the origin of sustained trigeminal pain.