Trigeminal neuralgia and persistent idiopathic facial pain

Abstract

Trigeminal neuralgia (TN) and persistent idiopathic facial pain (PIFP) are two of the most puzzling orofacial pain conditions and affected patients are often very difficult to treat. TN is characterized by paroxysms of brief but severe pain followed by asymptomatic periods without pain. In some patients a constant dull background pain may persist. This constant dull pain sometimes makes the distinction from PIFP difficult. PIFP is defined as continuous facial pain, typically localized in a circumscribed area of the face, which is not accompanied by any neurological or other lesion identified by clinical examination or clinical investigations. The pain usually does not stay within the usual anatomic boundaries of the trigeminal nerve distribution and is a diagnosis of exclusion. Epidemiologic evidence on TN, and even more so on PIFP, is quite scarce, but generally both conditions are considered to be rare diseases. The etiology and underlying pathophysiology of TN, and more so PIFP, remain unknown. Treatment is based on only few randomized controlled clinical trials and insufficiently evaluated surgical procedures.

Keywords::

• atypical facial pain
• differential diagnosis
• pathophysiology
• persistent idiopathic facial pain
• treatment
• trigeminal neuralgia

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Notes

Differential diagnoses of facial pain that have to be considered in the assessment of patients with trigeminal neuralgia and persistent idiopathic facial pain; some of these seem quite obvious for the more experienced, but may pose a challenge for others.

SUNA: Short-lasting, unilateral neuralgiform headache attacks with autonomic symptoms; SUNCT: Short-lasting, unilateral neuralgiform headache attacks with conjunctival injection and tearing.