ATYPICAL FACIAL PAIN
Conditions:  Facial Neuralgias

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| DESCRIPTION | POSSIBLE CAUSES | SYMPTOMS | DIAGNOSIS 
| TREATMENTS | ONLINE RESOURCES |

DESCRIPTION
Atypical Facial Pain (ATFP) is a syndrome encompassing a wide group of facial pain problems. ATFP can have many different causes but the symptoms are all similar. Facial pain, often described as burning, aching or cramping, occurs on one side of the face, often in the region of the trigeminal nerve and can extend into the upper neck or back of the scalp. Although rarely as severe as trigeminal neuralgia, facial pain is continuous for ATFP patients, with few, if any periods of remission. Recent studies propose that ATFP is an early form of trigeminal neuralgia. Indeed, some patients have components of both ATFP and TN symptoms.  Earlier literature has linked ATFP to "psychological pathology." Recent studies, however have shown no such link exists.

POSSIBLE CAUSES
ATFP has many possible causes. In some cases, infections of the sinuses or teeth appear to be involved. Some studies postulate a   low-grade infectious and inflammatory process occurring over a long period can result in nerve damage and be the triggering factor for ATFP pain. Some believe that vascular compression of the trigeminal nerve in the same area that is postulated to lead to trigeminal neuralgia is a cause of ATFP although studies have shown that microvascular decompression rarely leads to pain relief in ATFP patients. Dental or some sort of physical trauma is also linked to ATFP. Several somewhat controversial studies postulate that a condition known as NICO - Neuralgia Inducing Cavitational Osteonecrosis is the cause of the neuralgia-like symptoms of atypical facial pain.

SYMPTOMS
Facial pain, often described as burning, aching or cramping, pinching, pulling, occurs on one side of the face, often in the region of the trigeminal nerve and can extend into the upper neck or back of the scalp. Although rarely as severe as trigeminal neuralgia, facial pain is continuous for ATFP patients, with few, if any periods of remission.

DIAGNOSIS
Diagnosing atypical facial pain is not an easy task. It's not unusual for ATFP patients to have undergone numerous dental procedures, seen multiple doctors and undergone many medical tests before being successfully diagnosed and treated. A diagnosis of ATFP is usually a process of elimination. When a patient complains of constant facial pain restricted to one side of the face, the physician must first rule out any other conditions. Tests include roentgenograms of the skull, MRI and/ or CT scan with particular attention to the skull base, careful dental and otolaryngolgic evaluation, and thorough neurological examination. Only after tests rule out other factors can a diagnosis of ATFP be made.

TREATMENTS
Treatment of ATFP can be difficult and perplexing for both doctor and patient. Medication is usually the first course of treatment. Surgical procedures such as microvascular decompression generally are not successful with ATFP patients.

The following drugs are used to treat atypical facial pain:

Amitriptyline. (Triptyl, Elavil)

  Gabapentin. (Neurontin).

  Pamelor

  Capsaicin

  Other pain relief strategies include:

Hot and cold compresses

Acupuncture

  Biofeedback

  Dental Splint

ONLINE RESOURCES

Professional Websites

Atypical Facial Pain
Excellent discussion of Atypical Facial Pain from emedicine.com