Atypical facial pain is a chronic pain going on in the area of the face which could not be explained by the most common conditions which may produce this kind of pain. Atypical facial pain is a diagnosis of exclusion. Thus, we have to rule out all other causes which might be causing the pain before labelling the patient to be suffering from Atypical facial pain.
Incidence of Atypical facial pain is around 1 % and is more common in females.
Signs and Symptoms
- Pain which may be dull aching, throbbing, burning or electric shock like sensation
- Pain may be continuous or intermittent
- Pain may be associated with other symptoms like tingling, burning, numbness.
- Hyperalgesia or Allodynia may be present
- Mental health disorders like anxiety or depression may be associated with this condition
- Aggravation of pain when tired or stressed
Differential diagnosis of Atypical facial pain
- Temporal arteritis
- Chronic sinusitis
- Dental abnormalities
- Myofascial pain syndrome
- Temporomandibular disorders
- Trigeminal neuralgia
- Glossopharyngeal neuralgia
- Nasopharyngeal carcinoma
JEEVISHA Protocol for management of Atypical facial pain:
A thorough examination of the patient is required to rule out any other cause for the pain mentioned in the differential diagnosis. Some imaging like CT Scan or MRI may be done for the same.
- Medications: Patients are started on some Neuropathic medications and muscle relaxants. Other medications are added depending on the patient’s presentation and requirement.
- Physiotherapy: Patients with component of Temporomandibular joint involvement are taught exercises to ease the pain and improve TMJ mobility.
- Dry needling: Multiple sessions of Dry needling is done in these patients targeting the muscles of mastication and other soft tissues.
- Fluoroscopy guided Sphenopalatine ganglion block/ Radiofrequency ablation
- Fluoroscopy/ Ultrasound guided stellate ganglion block/ Radiofrequency ablation
- Fluoroscopy/ Ultrasound guided peripheral nerve blocks like supraorbital, Infraorbital OR Mental nerves.
- Ultrasound guided prolotherapy for TMJ dysfunction