Atypical facial pain or persistent idiopathic facial pain is a persistent, burning or throbbing pain, usually on one side of the face. The unique feature of this condition is the lack of an identifiable cause. Diagnosis is very complex, and treatment consists of medicinal and therapeutic measures.
What is atypical facial pain?
Atypical facial pain refers to persistent pain in the face that cannot be classified as one of the known facial neuralgias. The term was coined in the early 20th century to distinguish the condition from typical facial pain caused by nerve disease. Today, the term persistent idiopathic (i.e., with no apparent cause) facial pain is also commonly used. The hallmark of atypical facial pain is a persistent burning or pressing pain, sometimes perceived as pulsating and drilling. It usually affects only one side of the face, rarely both sides, and often persists very excruciatingly for a long period of time. In between, several weeks or months may pass without any symptoms at all. A physical cause is not recognizable, the facial region of the pain is usually not precisely delimitable. Often, however, the area around the upper jaw hurts. Those affected by atypical facial pain are mainly women between the ages of 30 and 60; they account for about two-thirds of patients.
Causes
To date, the causes of atypical facial pain are unknown. On the one hand, one suspects an interaction with mental disorders, because many of those affected suffer from depression[ or psychosis. These mental illnesses are caused, among other things, by a disturbed household of neurotransmitters in the brain, which has also been found in patients with atypical facial pain. Other possible causes include stress, anxiety or other psychological stresses. However, this has not been clearly clarified. Frequently, atypical facial pain begins after minor procedures at the dentist. But a direct physical connection between the dental nerves and atypical facial pain is also not apparent.
Symptoms, complaints, and signs
In this condition, patients primarily suffer from severe pain in the face. The pain occurs in different regions and is described as drilling, stabbing or even burning. Often it does not occur permanently, but only irregularly. At night, facial pain can lead to severe sleep disturbances and thus to psychological upsets or depression. Many patients appear irritable due to the pain. The pain also spreads to the jaw, nose and eyes. The temples and cheeks can also be affected by the pain. Often, those affected also suffer from difficulty swallowing and can no longer take food and liquids without further ado. Pain in the back or neck is also not uncommon due to the facial pain and continues to reduce the quality of life. There are significant restrictions in everyday life and often also movement restrictions. Likewise, the pain in the face can also lead to headaches and thus cause disturbances in concentration. In some cases, paralysis occurs in addition to the pain, so that disturbances of sensitivity occur in the face.
Diagnosis and course
Atypical facial pain begins with irregular pain in one side of the face, usually in the upper jaw. It feels probing, pulsating, pressing, or burning. As it progresses, it occurs daily and manifests in different regions of the face. It hurts in the eye, temple, cheek, nose, or upper jaw. Atypical facial pain is persistent and not intermittent, as is the case with facial neuralgias. The pain worsens when it is cold. The face feels as if there is inflammation. In many sufferers, depressive mood occurs along with atypical facial pain, as well as various other physical complaints such as back pain, migraine, or neck pain. The diagnosis of atypical facial pain is difficult and very complex. It can only be made by exclusion.Thus, first of all, all possible examinations must be performed in order to exclude other diseases. This requires dental and ophthalmological examinations, as well as consultation with an ENT specialist. If no causes for the facial pain are found, a neurologist should use further diagnostic procedures to rule out a tumor in the head or a disease of the facial nerve (trigeminal neuralgia). It should also be clarified whether other types of headache, such as migraine or tension headache, underlie the atypical facial pain.
Complications
Most cases present with very severe facial pain that cannot be directly linked to a cause. Diagnosis also proves to be relatively complicated, so treatment is delayed in most cases. The person affected is severely restricted in his or her everyday life by the pain and suffers from a reduced quality of life. Constant pain leads to depression and other psychological complaints in many people. A general aggressive attitude and irritability can also occur and have a negative effect on social contacts. Pain from the face can also spread to other regions. This mainly affects the head and back. Not infrequently, the teeth also hurt and the patient suffers from a migraine. If the pain also spreads to the eyes, this can cause visual disturbances. Treatment is usually causal, but can primarily only relieve the pain. Painkillers are used for this purpose. Furthermore, relaxation exercises or massages can also help against the facial pain. If the pain occurs due to a psychological cause, treatment with a psychologist is usually necessary.
When should you see a doctor?
If there is a sudden onset of unilateral, burning or probing pain in the throat, nose, cheek, temple, eye or jaw that is not due to any specific cause, it is recommended to see a doctor immediately. The medical professional can diagnose the atypical facial pain based on a diagnosis of exclusion or identify another condition as the cause. Appropriate treatment – usually a combination of stress therapy and antidepressants in the case of atypical facial pain – can then be initiated. If the complaints remain untreated, further symptoms may develop. At the latest when the pain becomes chronic or physical symptoms such as migraine, neck pain or back pain are added, it is necessary to see a doctor. If the complaints occur in connection with psychological changes (including depressive moods and psychosomatic disorders), a doctor should be consulted immediately. Medical advice is particularly needed if the atypical facial pain recurs and increases in intensity over the course of several weeks to months. Accompanying medical treatment, behavioral therapy and psychological pain therapies may be considered.
Treatment and therapy
Treatment of atypical facial pain is not straightforward. Most often, analgesic medications are resorted to first, but this is not a permanent solution. Good experience has been made with tricyclic antidepressants, which favorably influence pain processing in the brain and additionally alleviate the frequently occurring psychological complaints. Anticonvulsant drugs promote relaxation and can support other relaxation methods such as autogenic training or progressive muscle relaxation. Massages can also help. Good experience has been made with transcutaneous electrical nerve stimulation (TENS). Here, the affected skin areas are treated with stimulation current via electrodes to generate a counter-stimulus to the pain. This calms the nervous system and activates the body’s own pain-relieving processes. Acupuncture has also proven effective in treating atypical facial pain. Since the psyche is always involved, behavioral therapy or the support of special pain therapists are also recommended.
Outlook and prognosis
The prospects of recovery from atypical facial pain are very individual and depend on the underlying disease present. For the most part, it is a mental illness. If this is diagnosed and treated by a therapist, an improvement of the symptoms is possible within a few weeks or months.This depends on cooperation with the patient, his or her understanding of the disease and independent cooperation. Under optimal conditions, the patient can be symptom-free within a short time and remain so for life. The more severe the disease, the more difficult the prognosis. This is particularly the case with chronic conditions or a lack of insight into the disease. Without therapeutic or medical help, the symptoms often remain permanently. In the course of life, changes may occur depending on individual circumstances. Some patients, with good self-reflection, succeed in recognizing and remedying the cause on their own. Many find this difficult, which contributes to a perpetuation or worsening of the symptoms. Relaxation techniques and targeted stress reduction are helpful and improve the prognosis. The administration of medication can also provide relief. In most cases, the patient also experiences freedom from symptoms. However, the pain often returns abruptly after discontinuation of the medication if the cause has not been corrected.
Prevention
Atypical facial pain cannot be specifically prevented. However, since it usually occurs together with psychological factors, a healthy lifestyle and avoidance of extreme psychological stress can prevent it to a certain extent. To prevent an already existing atypical facial pain from worsening, it is imperative to refrain from supposed help through operations in the facial area.
Aftercare
Atypical facial pain is now referred to as persistent idiopathic facial pain. Affected individuals first undergo acute treatment. This is followed by close follow-up care. This includes medical measures such as pain-relieving medication prescription, as well as psychosocial components. Outpatient follow-up visits and keeping a pain diary are examples of a follow-up therapy concept for persistent idiopathic facial pain. In addition, the prescribed medication dose must be discussed. The risk of addiction is particularly high in persistent pain syndromes such as atypical facial pain. Sufferers must therefore be introduced to strategies that provide pain relief without the potential for addiction. The attitude of the treating physicians is often problematic during follow-up care. They usually classify the pain problem as a sign of hypochondria. The reason is that, despite all differential diagnosis, there is no identifiable cause for atypical facial pain. In addition, women are more often affected than men. Therefore, some treating physicians are quick to conclude that chronic pain conditions indicate a psychologically induced disorder.
What you can do yourself
Because the cause of persistent idiopathic facial pain is not known to date, patients cannot take self-help measures that have a causal effect. However, the pain is probably related to psychological factors such as anxiety or stress. Here the patient can learn to cope better with such situations. Relaxation techniques such as yoga or autogenic training can be helpful. If the patient also suffers from depressive moods, which is quite often the case with persistent idiopathic facial pain, a medically prescribed therapy can be gently supported by naturopathic methods. Naturopathy relies above all on the mood-lifting effect of St. John’s wort. Corresponding preparations are available as tea, tablets or drops in pharmacies and health food stores. St. John’s wort increases sensitivity to light. Extensive sunbathing should therefore be avoided while taking this substance. St. John’s wort is also suspected of influencing the effect of the contraceptive pill. Women who use hormonal contraception should consult their gynecologist. Symptoms such as neck or back pain can be reduced by compensatory sports or by specific physiotherapeutic exercises. Regular medical massages can also prevent tension-related pain in the neck and shoulder area. In addition, acupuncture has also proven effective for idiopathic facial pain.
