Persistent Idiopathic Facial Pain 

  • Author: Stanley J Krolczyk, DO, RPh; Chief Editor: Robert A Egan, MD   more...
 
Updated: Jan 14, 2010
 

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.[1] 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)[2] :

  • 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.

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Epidemiology

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.[3]

Sex

PIFP affects both sexes approximately equally, but more women than men seek medical care.[3]

Age

The disorder mainly affects adults and is rare in children.[3]

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Contributor Information and Disclosures
Author

Stanley J Krolczyk, DO, RPh  Assistant Professor, Director of Multiple Sclerosis Center, Department of Neurology, University of South Florida College of Medicine

Stanley J Krolczyk, DO, RPh is a member of the following medical societies: American Academy of Neurology, American Headache Society, American Medical Association, and American Osteopathic Association

Disclosure: TEVA Grant/research funds CLINICAL TRIALS; TEVA Consulting fee Speaking and teaching; EMD SERONO Consulting fee Speaking and teaching; BIOGEN Consulting fee Speaking and teaching; EMD SERONO Grant/research funds CLINICAL TRIALS

Coauthor(s)

Kavita Kalidas, MD  Fellow, Department of Neurology, University of South Florida

Kavita Kalidas, MD is a member of the following medical societies: American Academy of Neurology, American Medical Association, and American Pain Society

Disclosure: Nothing to disclose.

Martin A Myers  University of South Florida College of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Joseph Carcione Jr, DO, MBA  Consultant in Neurology and Medical Acupuncture, Medical Management and Organizational Consulting, Central Westchester Neuromuscular Care, PC; Medical Director, Oxford Health Plans

Joseph Carcione Jr, DO, MBA is a member of the following medical societies: American Academy of Neurology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Robert A Egan, MD  Director of Neuro-Ophthalmology, St Helena Hospital

Robert A Egan, MD is a member of the following medical societies: American Academy of Neurology, American Heart Association, North American Neuro-Ophthalmology Society, and Oregon Medical Association

Disclosure: Nothing to disclose.

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association

Disclosure: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

Chief Editor

Robert A Egan, MD  Director of Neuro-Ophthalmology, St Helena Hospital

Robert A Egan, MD is a member of the following medical societies: American Academy of Neurology, American Heart Association, North American Neuro-Ophthalmology Society, and Oregon Medical Association

Disclosure: Nothing to disclose.

References

  1. Pascual J, Colas R, Castillo J. Epidemiology of chronic daily headache. Curr Pain Headache Rep. Dec 2001;5(6):529-36. [Medline].

  2. Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalalgia. 2004;24 Suppl 1:9-160. [Medline].

  3. Kavuk I, Yavuz A, Cetindere U, Agelink MW, Diener HC. Epidemiology of chronic daily headache. Eur J Med Res. Jun 30 2003;8(6):236-40. [Medline].

  4. Bordini C, Antonaci F, Stovner LJ, Schrader H, Sjaastad O. "Hemicrania continua": a clinical review. Headache. Jan 1991;31(1):20-6. [Medline].

  5. Madland G, Feinmann C. Chronic facial pain: a multidisciplinary problem. J Neurol Neurosurg Psychiatry. Dec 2001;71(6):716-9. [Medline].

  6. Volcy M, Rapoport AM, Tepper SJ, Sheftell FD, Bigal ME. Persistent idiopathic facial pain responsive to topiramate. Cephalalgia. Apr 2006;26(4):489-91. [Medline].

  7. Kaup AO, Mathew NT, Levyman C, Kailasam J, Meadors LA, Villarreal SS. 'Side locked' migraine and trigeminal autonomic cephalgias: evidence for clinical overlap. Cephalalgia. Feb 2003;23(1):43-9. [Medline].

  8. Leone M, D'Amico D, Frediani F, Torri W, Sjaastad O, Bussone G. Clinical considerations on side-locked unilaterality in long-lasting primary headaches. Headache. Jul-Aug 1993;33(7):381-4. [Medline].

  9. Turp JC, Gobetti JP. Trigeminal neuralgia versus atypical facial pain. A review of the literature and case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Apr 1996;81(4):424-32. [Medline].

  10. Cunningham AL, Dworkin RH. The management of post-herpetic neuralgia. BMJ. Sep 30 2000;321(7264):778-9. [Medline].

  11. Rozen TD. Trigeminal Autonomic Cephalgias. Continuum. Dec 2006;12:170-93.

  12. Watson P, Evans R. Cluster-tic syndrome. Headache. May 1985;25(3):123-6. [Medline].

  13. Pareja JA, Sjaastad O. SUNCT syndrome. A clinical review. Headache. Apr 1997;37(4):195-202. [Medline].

  14. Pareja JA, Ruiz J, de Isla C, al-Sabbah H, Espejo J. Idiopathic stabbing headache (jabs and jolts syndrome). Cephalalgia. Apr 1996;16(2):93-6. [Medline].

  15. Mokri B. Raeder's paratrigeminal syndrome. Original concept and subsequent deviations. Arch Neurol. Jul 1982;39(7):395-9. [Medline].

  16. Kuritzky A. Indomethacin-resistant hemicrania continua. Cephalalgia. Feb 1992;12(1):57-9. [Medline].

  17. Peres MF, Silberstein SD, Nahmias S, et al. Hemicrania continua is not that rare. Neurology. Sep 25 2001;57(6):948-51. [Medline].

  18. Ogutcen-Toller M, Uzun E, Incesu L. Clinical and magnetic resonance imaging evaluation of facial pain. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. May 2004;97(5):652-8. [Medline].

  19. Rozen TD. Antiepileptic drugs in the management of cluster headache and trigeminal neuralgia. Headache. Nov-Dec 2001;41 Suppl 1:S25-32. [Medline].

  20. Alberca R, Ochoa JJ. Cluster tic syndrome. Neurology. Jun 1994;44(6):996-9. [Medline].

  21. Carrazana E, Mikoshiba I. Rationale and evidence for the use of oxcarbazepine in neuropathic pain. J Pain Symptom Manage. May 2003;25(5 Suppl):S31-5. [Medline].

  22. Delvaux V, Schoenen J. New generation anti-epileptics for facial pain and headache. Acta Neurol Belg. Mar 2001;101(1):42-6. [Medline].

  23. Evans RW, Agostoni E. Persistent idiopathic facial pain. Headache. Sep 2006;46(8):1298-300. [Medline].

  24. Jaaskelainen SK. Clinical neurophysiology and quantitative sensory testing in the investigation of orofacial pain and sensory function. J Orofac Pain. Spring 2004;18(2):85-107. [Medline].

  25. Katusic S, Beard CM, Bergstralh E, Kurland LT. Incidence and clinical features of trigeminal neuralgia, Rochester, Minnesota, 1945-1984. Ann Neurol. Jan 1990;27(1):89-95. [Medline].

  26. Pareja JA, Caminero AB, Sjaastad O. SUNCT Syndrome: diagnosis and treatment. CNS Drugs. 2002;16(6):373-83. [Medline].

  27. Pettengill CA, Reisner-Keller L. The use of tricyclic antidepressants for the control of chronic orofacial pain. Cranio. Jan 1997;15(1):53-6. [Medline].

  28. Piedimonte F, Schvarcz JR. Stereotactic trigeminal nucleotomy for dysesthetic facial pain. Stereotact Funct Neurosurg. 1997;68(1-4 Pt 1):175-81. [Medline].

  29. Reisner L, Pettengill CA. The use of anticonvulsants in orofacial pain. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Jan 2001;91(1):2-7. [Medline].

  30. Swift JQ, Roszkowski MT. The use of opioid drugs in management of chronic orofacial pain. J Oral Maxillofac Surg. Sep 1998;56(9):1081-5. [Medline].

  31. Türp JC, Kowalski CJ, Stohler CS. Pain descriptors characteristic of persistent facial pain. J Orofac Pain. Fall 1997;11(4):285-90. [Medline].

  32. Wahlund K, List T, Dworkin SF. Temporomandibular disorders in children and adolescents: reliability of a questionnaire, clinical examination, and diagnosis. J Orofac Pain. Winter 1998;12(1):42-51. [Medline].

 
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