Influence of headache and craniofacial neuralgia on driving

Facial and cranial pain differs from all other types of body pain in its unique psychological dimension
Facial and cranial pain differs from all other types of body pain in its unique psychological dimension

Craniofacial pain

Trigeminal neuralgia is characterised by an intense facial pain that makes any activity impossible.

Glossopharyngeal neuralgia starts with pain at the bottom of pharynx and irradiates to the ear and mandibular angle. Pain is always unilateral. Treatment and risks are the same as for trigeminal neuralgia.

Arnold’s occipital neuralgia is characterised by being paroxysmal and located in the occipital and suboccipital region. It is triggered by head motion and mild pressure on the occipital area.


  • Carbamazepine is an effective drug, but because of its mild cholinergic effects requires close monitoring in patients with increased ocular pressure.
  • Physicians should warn of this risk when driving when pain subsides but treatment is continued, because this cannot be abruptly discontinued, even if the patient is asymptomatic.
  • Dosage should be adequately adjusted in each patient, because high plasma levels may cause adverse effects such as dizziness, drowsiness, diplopia, and ataxia.
  • Alcohol tolerance may also be decreased. No alcohol can be drunk when driving.


Symptomatic, localised anterior headache may be due to an infectious, rhinosinusal or otic cause, be post-traumatic, or caused by visual fatigue, refractive changes, or strabismus, among other reasons.

Vascular and sympathetic headache may be due to hepatic, endocrine, specific sensitization, or psychical changes. These types of headache cause unilateral, throbbing pain, and neurovegetative changes including flushing, pallor, sweating, tearing, nasal discharge, sneezing, nausea, and vomiting.

  • Migraine is unilateral, located in the orbital frontal area, and may be associated to vertigo.
  • Horton’s disease causes pain in the territory of the superficial temporal artery.
  • Sluder syndrome, or sphenopalatine ganglion neuralgia, causes localised pain at the nasal root, orbit, and upper part of the cheek and upper teeth.
  • Charlin’s, or ciliary ganglion, syndrome causes highly severe pain in the nasal nerve area, located around the orbit.

Posterior headache is very common in lorry drivers because of prolonged contracture of muscles in the back of the neck.

  • Unilateral radicular neck pain is caused by osteoarthritis, slipped disk, inadequate posture, etc.
  • Cervical vascular sympathetic syndrome causes occipital headache with anterior retro-orbital irradiation, that is associated to cochleovestibular signs preventing driving due to vertigo, hypoacusis, and tinnitus.

This is usually caused by a cervical lesion such as osteoarthritis, and by irritation of vertebral sympathetic nerves. Hepatic, neuroendocrine, and psychical changes promote the occurrence of the clinical picture.


  • Glossopharyngeal neuralgia and Arnold ‘s occipital neuralgia: adequate adjustment of the neck or head rest is recommended.
  • Headache: in patients with anterior headache, an analgesic treatment that does not interfere with driving is recommended, as well as control of the underlying cause to allow for risk-free driving.
  • Cefaleas vasculares y simpáticas:
    • In vascular headache, driving limitations are caused by pain, the underlying general disease, and associated symptoms.
    • Effective treatment is based on ergotamine, vasodilators, antihistamines and, often, analgesics associated to codeine.
    • The latter should be prescribed with caution, warning patients that they decrease concentration and skills, and interfere with driving and use of machines.
  • Posterior headache:
    • For long car travel, an increase in the number of stops is recommended to rest the spine and relax muscles.
    • A comfortable driver seat and back, adjusted in height and distance to the driving wheel, is essential. Rearview mirrors should be well oriented to avoid forcing the neck.
    • If the head rest is not in an adequate position, there is an added risk of neck damage in the event of a crash.
    • It is important to search for comfort inside the vehicle, so that driving is relaxing and relieves headache instead of causing it.
    • Driving is not allowed with cochleovestibular symptoms.
    • The specialist will treated the associated disease, and will tell the patient when he/she can drive again.
    • Patients often take anti-inflammatory, anxiolytic, and relaxing drugs not knowing their side effects on driving. Addicts to these drugs are commonly seen because of the rewarding effect of disappearance of a bothersome headache.
    • Many drivers experience headache, that becomes even more severe, when they are driving in the city. They become irritated, uneasy, and intolerant to traffic.
    • They drive clinching their teeth in such a way that they cause masseter muscles to contract, resulting in a severe pain irradiating to the head that causes them to be even in a worse temper while driving.
    • In addition to drug therapy, psychical therapy should also be sometimes indicated.
    • Our patients should be reminded not to take medicines that cause drowsiness while driving their vehicles. Many of them have the glove box of the car full of pills, just as if they were sweets.
    • Helping drivers analyse their personal situation and search for the cause of headache will relieve their anxiety and help them find a solution without taking too many drugs.