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].