Facial Pain

This is a common condition and Practitioners can often treat the underlying cause once this has been identified e.g., sinusitis, migraine. If local measures fail, consider whether the cause could be psychogenic, CNS pathology or an occult local cause. Majority of diagnosis are based on accurate history (good pain history) and exclusion. It may be impossible to differentiate without hospital based facilities and then referral is indicated.

Paroxysmal Trigeminal Neuralgia

PRESENTATION

Severe lightening bursts of pain lasting only a few seconds. Patients often have 'trigger zones' which respond to touch or cold by initiating an attack.

TREATMENT

Carbemazepine starting with a dose of 100mg BD and increasing to a maximum of 1600mg per day in divided doses.

• Phenytoin
• Gabapentin

Adverse drug reactions or failure to respond indicate a need for surgery.

Nerve blocks and cryosurgery are often helpful at a local level but intractable cases are referred on to the Neurosurgery Department at Frenchay Hospital .

NB. Dull, chronic, throbbing pain is not trigeminal neuralgia.

For patients presenting with trigeminal neuralgia under the age of 40, a diagnosis of multiple sclerosis must be considered.

Facial dysaesthesia and pain (Atypical Facial pain)

This may be psychogenic in origin and any information relating to psychiatric disorders or stress factors e.g. chronic illness in the family, saves consultation time.

Facial anaesthesia or paraesthesia is a much less common symptom than pain and merits early referral to exclude aggressive pathology.