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Excerpt from Persistent Idiopathic Facial Pain


Synonyms, Key Words, and Related Terms: trigeminal nerve, trigeminal neuralgia, TMJ, temporomandibular joint syndrome, TMJ syndrome, migraine, headache, cluster headache

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Background

The term atypical facial pain was first introduced by Frazier and Russell in 1924. It has since been renamed persistent idiopathic facial pain (PIFP). PIFP refers to pain along the territory of the trigeminal nerve that does not fit the classic presentation of other cranial neuralgias (Pascual, 2001). The duration of pain is usually long, lasting most of the day (if not continuous). Pain is unilateral and without autonomic signs or symptoms. It is described as a severe ache, crushing sensation, or burning sensation. Upon examination and workup, no abnormality is noted.

The International Headache Society defines PIFP as follows (Headache Classification Subcommittee of the International Headache Society, 2004):

  • 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 localized.
  • In addition, the pain is not associated with sensory loss or other physical signs, with no abnormalities in laboratory or imaging studies.

Within the group of chronic facial pain syndromes, PIFP represents a diagnostic challenge. Patients frequently are misdiagnosed or attribute their pain to a prior event such as a dental procedure or facial trauma. Psychiatric symptoms of depression and anxiety are prevalent in this population and compound the diagnostic conundrum. Treatment is less effective than in other facial pain syndromes and requires a multidisciplinary approach to address the many facets of this pain syndrome.

Frequency

United States

Accurate figures are difficult to obtain because of the lack of agreement on classification criteria. Estimated incidence is 1 case per 100,000 population, although this number may be underestimated (Kavuk, 2003).

Sex

PIFP affects both sexes approximately equally, but more women than men seek medical care (Kavuk, 2003).

Age

The disorder mainly affects adults and is rare in children (Kavuk, 2003).

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