Atypical (persistent idiopathic) facial pain

Atypical (persistent idiopathic) facial pain is chronic facial pain without evidence of structural cause (see description in Facial pain types). Magnetic resonance imaging with gadolinium may be needed to exclude tumour (eg squamous cell carcinoma) growth along a facial nerve as the cause of pain.

Bilateral pain, hypoaesthesia, other chronic pains and depression are more prevalent than in trigeminal neuralgia. Conversely, stabbing pain, touch-evoked pain and remission periods are less prevalent.

Atypical facial pain is treated with the same drugs as neuropathic pain. Combination therapies (eg an antidepressant with an anticonvulsant) may have benefit. Atypical facial pain can be exacerbated by stress, so assess the patient for psychological problems and manage appropriately.