Atypical 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 burning sensation.

Recent studies propose that ATFP is an early form of trigeminal neuralgia (TN). Indeed, some patients have components of both ATFP and TN symptoms.

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 diagnostic puzzle.

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 children.

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 treated.

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 examination.

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.