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Atypical Facial Pain
(Persistent 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
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.


Useful Websites:

Facial Neuralgia Resources

Eastman Dental Institute Oral Medicine Clinic - Atypical Facial
Pain Information Sheet

Emedicine.com (Neurology)

European Association of Oral Medicine


Useful Articles:

Dental Update 1999.  Orofacial Pain

British Medical Journal 2000.  ABC of Oral Health - Oro-facial
Soreness and Pain

British Dental Journal 2006.  Oral Medicine, Update for the
GDP - Oro-Facial Pain
Last Updated 22nd November 2010