Facial Pain: A Comprehensive Review and Proposal for a Pragmatic Diagnostic Approach

Eur Neurol. 2020;83(1):5-16. doi: 10.1159/000505727. Epub 2020 Mar 27.

Abstract

Background: Facial pain, alone or combined with other symptoms, is a frequent complaint. Moreover, it is a symptom situated at, more than any other pain condition, a crosspoint where several disciplines meet, for example, dentists; manual therapists; ophthalmologists; psychologists; and ear-nose-throat, pain, and internal medicine physicians besides neurologists and neurosurgeons. Recently, a new version of the most widely used classification system among neurologists for headache and facial pain, the International Classification of Headache Disorders, has been published.

Objective: The aims of this study were to provide an overview of the most prevalent etiologies of facial pain and to provide a generic framework for the neurologist on how to manage patients presenting with facial pain.

Methods: An overview of the different etiologies of facial pain is provided from the viewpoint of the respective clinical specialties that are confronted with facial pain. Key message: Caregivers should "think outside their own box" and refer to other disciplines when indicated. If not, a correct diagnosis can be delayed and unnecessary treatments might be given. The presented framework is aimed at excluding life- or organ-threatening diseases, providing several clinical clues and indications for technical investigations, and ultimately leading to the correct diagnosis and/or referral to other disciplines.

Keywords: Classification; Cranial neuralgia; Facial pain; Persistent idiopathic facial pain; Trigeminal neuralgia.

Publication types

  • Review

MeSH terms

  • Facial Pain / diagnosis*
  • Facial Pain / etiology*
  • Facial Pain / therapy*
  • Female
  • Humans
  • Male
  • Neurology / methods