Definition

Atypical facial pain, a pain disorder of the face, is often compared to trigeminal neuralgia but is a different entity. Symptoms are more persistent, with few, if any, periods of remission. Pain is usually localized to one side of the face and can be described as sharp, dull, crushing, aching, burning, pulling or squeezing.There are many possible causes of ATFP, and diagnosis is usually reached through a process of elimination. Unfortunately, the treatment options are fewer than for trigeminal neuralgia and frequently less effective.

Causes

Atypical facial pain, once thought to be psychological in origin, is now recognized as a neurological disease with a large number of possible causes including:

  • Sinus infections
  • Dental infections
  • Ernest Syndrome (inflammation of a ligament in the jaw)
  • Neuralgia inducing cavitational osteonecrosis
  • Temporal tendonitis
  • Vagus nerve tumors
  • Trigeminal ganglia compression
  • Facial trauma
  • Trigeminal nerve trauma
  • Cervical spine disorders

Risk Factors

Risk factors associated with an increased chance of developing atypical facial pain include:

  • Facial injury
  • Extensive dental work
  • Infections or inflammation
  • Age (the condition is rarely seen in children)

Symptoms

Atypical facial pain is usually localized to one side of the face and can be described as sharp, dull, crushing, aching, burning, pulling or squeezing. It often occurs over the region of the trigeminal nerve, but the pain can also affect the scalp and neck. The condition is different from other facial pain syndromes by its persistent presence; with other disorders, patients tend to experience periods of remission, but this is not the case with atypical facial pain.

Diagnosis

  • The first step in diagnosing atypical facial pain is a neurological examination. The physician will try to rule out similar conditions such as trigeminal neuralgia, temporomandibular joint syndrome, migraines and cluster headaches.
  • Finally, imaging may help pinpoint the cause:
    • X-Rays of the skull
    • MRI/CT scan

Treatment    

Because there are numerous possible causes for atypical facial pain, finding the appropriate treatment can be an arduous process. Medical management is preferred and is generally the most effective. Existing surgical options rarely provide relief.

  • Medications:
    • Amitriptyline (antidepressant)
    • Gabapentin (anticonvulsant)
    • Carbamazepine (anticonvulsant)
    • Baclofen (muscle relaxant/antispasmodic)
    • Clonazepam (muscle relaxant/anticonvulsant)
    • Valproic (anticonvulsant)
  • Invasive Procedures:
    • Microvascular decompression
    • Glycerol injection
    • Balloon compression
    • Peripheral nerve stimulation
    • Stereotactic radiosurgery
    • Percutaneous trigeminal tractotomy
    • Motor cortex stimulation

Prevention

There are no prevention strategies for atypical facial pain.

Disclaimer

Content generated and provided by Joshua B. Bederson, MD, Professor and Chairman of the Department of Neurosurgery at The Mount Sinai Health System. Some of the information contained in this article was adapted from the National Institutes of Health. Last reviewed June 2011 by the Department of Neurosurgery at The Mount Sinai Health System.

If you want to learn more about treating atypical facial pain, call the Mount Sinai Department of Neurosurgery at 212-241-2377.