Persistent Idiopathic Facial Pain

Pain Practice

Volume 9 Issue 6, Pages 443 - 448, Published Online: 27 Oct 2009, © 2009 by World Institute of Pain

EVIDENCE-BASED MEDICINE

Evidence-Based Interventional Pain Medicine according to Clinical Diagnoses

Paul Cornelissen, MD*; Maarten van Kleef, MD, PhD, FIPP ^† ; Nagy Mekhail, MD, PhD, FIPP ^‡ ; Miles Day, MD, FIPP, DABIPP ^§ ; Jan van Zundert, MD, PhD, FIPP ^†¶

*Department of Anesthesiology and Pain Management, Jeroen Bosch Ziekenhuis,'s Hertogenbosch, The Netherlands; ^† Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, The Netherlands; ^‡ Pain Management Department Cleveland Clinic, Cleveland, Ohio, U.S.A.; ^§ Department of Anesthesiology and Pain Management Texas Tech University HSC, Lubbock, Texas, U.S.A.; ^¶ Department of Anesthesiology and Multidisciplinary Pain Centre, Ziekenhuis Oost-Limburg, Genk, Belgium

Correspondence to Maarten van Kleef, MD, PhD, FIPP, Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands. E-mail: maarten.van.kleef@mumc.nl.

ABSTRACT

Persistent idiopathic facial pain, previously known as atypical facial pain, is described as a persistent facial pain that does not have the classical characteristics of cranial neuralgias and for which there is no obvious cause (International Classification of Headache Disorders in 2004). According to these criteria, the diagnosis is possible if the facial pain is localized, present daily, and throughout all or most of the day. By definition, neurological and physical examination findings in persistent idiopathic facial pain should be normal. Forming a diagnosis is not simple and follows a process of elimination of other causes of facial pain.

The precise incidence is unknown. The affliction is seen primarily in older adults and rarely in children. The pathophysiology is unknown. In persistent idiopathic facial pain, there is no abnormal processing of somatosensory stimuli in the pain area or facial area of the primary somatosensory cortex of the brain.

The treatment is difficult and often requires a multidisciplinary approach. The most important part of the treatment is psychological counseling and pharmacological therapy. Pharmacological treatment with tricyclic antidepressants and anti-epileptic drugs can be tried. The conservative, pharmacological treatment with amitryptiline is the primary choice. Venlafaxine and fluoxetine treatment can also be considered.

When the pharmacological treatment fails, pulsed radiofrequency treatment of the ganglion pterygopalatinum (sphenopalatinum) can be considered (2 C+).

Miraine Presenting As Chronic Facial Pain

Acta Neurologica Belgica
2009, N° 3 (Vol. 109/3) p.235-237 F. Debruyne and L. Herroelen, Headache Clinic, Department of Neurology, University Hospital UZ Gasthuisberg, Leuven, Belgium

Abstract:
We report the case of a 44 year old woman with chronic facial pain. She was treated with several analgesics, prophylactic medications and infiltrations, but all treatment modalities were ineffective. Finally, the diagnosis of medication-overuse headache complicating migraine without aura was made and an appropriate treatment was initiated. Migraine is a very common primary headache and rarely presents as isolated facial pain. Stimulation of the dura with activation of the trigeminovascular system can result in pain in any of the three divisions of the trigeminal nerve. This is the anatomic basis of migraine pain presenting as referred pain to the second division of the trigeminal nerve. The atypical presentation of migraine pain can easily lead to inappropriate treatment regimens

Post-Traumatic External Nasal Pain Syndrome (a Trigeminal Based Pain Disorder)

Post-Traumatic External Nasal Pain Syndrome (a Trigeminal Based Pain Disorder)
Headache: The Journal of Head and Face Pain
Volume 49 Issue 8, Pages 1223 - 1228
Todd Rozen, MD
From the Michigan Head Pain & Neurological Institute – Neurology, Ann Arbor, MI, USA.
Correspondence to T. Rozen, Michigan Head Pain & Neurological Institute, 3120 Professional Drive, Ann Arbor, MI 48104, USA.
Conflict of Interest: None

Copyright Copyright © 2009 American Headache Society
KEYWORDS
trigeminal nerve • facial pain • headache • nasal pain • sphenopalatine ganglion
(Headache 2009;49:1223-1228)

ABSTRACT
Little has been written about persistent external nasal pain after injury to the nose in the neurologic or headache literature. In clinical practice, this can be a disabling and treatment refractory condition. The external portion of the nose is highly innervated by branches of the ophthalmic and maxillary divisions of the trigeminal nerve including the nasociliary nerve, external nasal nerve, infratrochlear nerve, anterior ethmoidal nerve, and infraorbital nerve. As these nerves are located on the external portion of the nose just deep enough to the skin they can be easily traumatized with any impact to the nose.

Four patients with what is termed the post-traumatic external nasal pain syndrome are reported in this paper, describing the clinical presentation of the disorder and providing treatment options. Post-traumatic external nasal pain syndrome appears to be a novel form of trigeminal-based pain not previously reported in the neurologic literature.


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Accepted for publication May 18, 2009.

DIGITAL OBJECT IDENTIFIER (DOI)
10.1111/j.1526-4610.2009.01485.x About DOI