Atypical Facial Pain
By: Brooklyn A. Bradley, BS; Medically edited by Dr. Deena Kuruvilla, MD
Atypical facial pain (AFP) is used as an umbrella term for unclassifiable pain syndromes of the face [1]. AFP is when a patient experiences unexplained, ongoing pain in their face without a clear cause [2]. It can also be defined as persistent idiopathic facial pain (PIFP). This pain can be felt in the teeth, jaw, cheek, or ear. AFP can be difficult to diagnose, and frustrating for the patient experiencing the pain.
Anyone can get AFP; however, it is more common in females in their 40s or 50s. In addition, patients with a past history of dental injuries or mouth surgery may have an increased likelihood of AFP [2]. AFP affects less than 1% of the population, but it is possible that a number of people have been misdiagnosed and actually have AFP. The symptoms are similar to other face and mouth conditions such as trigeminal neuralgia [2]. Trigeminal neuralgia is also a chronic pain condition, and it affects a widely distributed nerve in the head – the trigeminal or 5th cranial nerve [3]. The classic form of trigeminal neuralgia causes sporadic and sudden burning or shock-like facial pain that lasts anywhere from a few seconds to as long as 2 minutes. Trigeminal neuralgia can be triggered if a blood vessel is pressing on the trigeminal nerve as it leaves the brain stem [3].
AFP does not have a defined cause; however, some researchers speculate that it is connected to psychological disease. For example, depression, anxiety, and other mental health conditions alter the functioning of neurotransmitters (chemical messengers in the brain), which can change how we feel pain and make us more sensitive [2]. Patients with AFP usually have facial pain for at least 3 months, and many things can trigger it. For instance, heat, cold, touch, or stress may start an AFP episode. The pain does not follow the path of a nerve, and can vary in where it is felt on the face. Some patients may feel the pain on one side of the face near the jaw or ear. Others may feel it is contained to one small area, or widespread across the entire face [2]. AFP has been reported as shooting, burning, deep, throbbing, and tingling in its nature.
Diagnosing AFP can be very difficult. The diagnosis is based on severity of symptoms, location of the pain, and the frequency, intensity, and duration of pain [4]. It is commonly misdiagnosed as a dental problem and as a result,people may go through several unnecessary dental procedures. Your doctor will obtain a thorough medical history and perform a physical exam to rule out other medical conditions linked to facial pain. The physical examination of the head, face, and neck allow the specialist to identify the location of the pain and determine if there are other factors that may be the source of the pain [4]. An MRI scan may be recommended to get a better view of the head and neck. The primary treatment for AFP is medication to decrease the pain or even prevent it. Prescription medications such as antiepileptics, antidepressants, and muscle relaxants may be used. The neurologist will recommend a plan that gives the best possible pain relief, while minimizing side effects [4].
Many people with AFP respond well to medication, therapy, or integrative treatments. It is important to talk to your healthcare provider about what you are experiencing. The specialist will perform a variety of diagnostic tests to rule out other conditions that may be causing facial pain, and they will recommend the best course of treatment.
References:
- Pfaffenrath V, Dieterich M (1995) [Diagnosis and treatment of atypical facial pain-a review.]. Schmerz 9:235–241. https://doi.org/10.1007/BF02529444
- Atypical Facial Pain (AFP): Causes, Symptoms, Diagnosis & Treatment. In: Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/21822-atypical-face-pain. Accessed 28 Oct 2022
- Trigeminal Neuralgia Fact Sheet | National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/trigeminal-neuralgia-fact-sheet. Accessed 28 Oct 2022
- Diagnosing Atypical Facial Pain. https://nyulangone.org/conditions/atypical-facial-pain/diagnosis. Accessed 28 Oct 2022