For diagnosis of atypical facial pain (ATFP), the international
classification of headache disorders has described the following
criteria [12]:
1. Facial pain recurring for more than 2 hours in a day for a period of
3 months
2. Poorly localized, dull aching, or nagging pain
3. Clinical neurological examination and dental examination are normal
Physicians still diagnose atypical facial pain by exclusion as all these
symptoms are nonspecific. A complete clinical examination must rule out
other causes like dental infections, vascular factors, craniofacial
tumors, trigeminal neuralgia, and migraine. Radiological diagnosis,
including computed tomography or magnetic resonance imaging, should
support the diagnosis [12,13]. Especially if the patient is a
smoker, a chest radiograph is essential to rule out lung neoplasms
presenting as facial pain [6]
Thus, a multidisciplinary approach is essential for the diagnosis of
atypical facial pain [14]
Treatment of ATFP is often unsatisfactory, so patient education often
becomes essential [15]. Antidepressants [4], which include
amitriptyline, duloxetine, venlafaxine, and Anticonvulsants [10]
(carbamazepine, oxcarbazepine, phenytoin, gabapentin, lamotrigine) have
been used to treat ATFP. Other agents that give relief are botulinum
toxin A, local anaesthetics like lignocaine, muscle relaxants
(baclofen), phentolamine, and selective serotonin receptor agonists
(sumatriptan) [16]. As this is neuropathic pain, high-frequency
repetitive transcranial magnetic stimulation (rTMS) on the right
somatosensory cortex aborted pain significantly [17]. Chemotherapy
is the least effective [15]. Radiotherapy, vagotomy, and tumor
resection are the standard forms of treatment for ATFP [7]. Patients
respond excellently to resection, but surgery is not possible due to
delayed diagnosis as 79℅ of patients have had a regional spread.
Radiation therapy also helps to ameliorate pain, but the response occurs
over months. Most patients die before pain relief is obtained [15].