|Atypical Facial Pain
(Persistent / Chronic
Idiopathic Facial Pain)
What is Atypical Facial Pain?
Atypical Facial Pain (ATFP), also known as Persistent
Idiopathic Facial Pain (PIFP) is a syndrome encompassing
a wide group of facial pain problems.
ATFP refers to pain within the territory of the Trigeminal
Nerve (it can extend into the upper neck or back of the scalp
as well) that does not fit the classic presentation of other
head and neck neuralgias.
The duration of pain is usually long, lasting most of the day
(if not continuous). Pain is one-sided and without autonomic
signs or symptoms.
It is described as a severe ache, crushing sensation or
Recent studies propose that ATFP is an early form of
trigeminal neuralgia (TN). Indeed, some patients have
components of both ATFP and TN symptoms.
|Last Updated 13th July 2016
|Treatment Algorithm for Atypical Facial Pain
|What are the Signs & Symptoms of Atypical Facial Pain?
The International Headache Society defines ATFP as the following:
- Pain is in the face
- Pain is present daily and persists for all or most of the day
- Pain is confined at onset to a limited area on one side of the face, deep ache,
and poorly localised
In addition, the pain is not associated with numbness or tingling or other physical
signs with no abnormalities in laboratory or imaging studies.
Within the group of chronic facial pain syndromes, ATFP represents a diagnostic
challenge. Patients frequently are misdiagnosed or attribute their pain to a prior
event such as a dental procedure or facial trauma.
Depression and anxiety are prevalent in this population and compound the
The estimated incidence of ATFP is 1 in a 100,000, although this number may be
an underestimate. ATFP affects both sexes approximately equally but more
women than men seek medical care. ATFP mainly affects adults and is rare in
How Is It Diagnosed?
Diagnosing atypical facial pain is not an easy task. It's not unusual for ATFP
patients to have undergone numerous dental procedures, seen numerous doctors
and undergone numerous medical tests before being successfully diagnosed and
When a patient complains of constant facial pain restricted to one side of the face,
the doctor / dentist must first rule out any other conditions.
Tests include X-rays of the skull, MRI or CT scan with particular attention to the
skull base, careful dental and ENT evaluation and thorough neurological
Only after tests rule out other factors can a diagnosis of ATFP be made.
How is it treated?
Treatment is less effective than in other facial pain syndromes.
Medication is usually the first course of treatment.
Surgical procedures generally are not successful with ATFP patients.
Anti-convulsants and anti-depressants are the mainstays of medication treatment.
Alternative therapies such as acupuncture and neuro-muscular re-education have
been tried and should be considered as part of a comprehensive treatment plan.