Other causes of facial pain

Question 1

Glossopharyngeal neuralgia

Answer 1

This is a rare condition with similar clinical features of severe laminating pains.

Sites:

• Back of throat around tonsillar fossa
• and adjacent fauces deep in ear.
• May extend to external ear and neck.

Triggers: swallowing, coughing, talking

Treatment: as for trigeminal neuralgia

Question 2

Facial migraine (lower half headache)

Answer 2

Migraine may rarely affect the face below the level of the eyes,

• causing pain in the area of the cheek and upper jaw.

It may spread over the nostril and lower jaw.

Pain is dull and throbbing and nausea and vomiting are commonly present.

Treatment is as for other varieties of migraine.

Question 3

Chronic paroxysmal hemicrania

Answer 3

In the rare condition of chronic or episodic paroxysmal hemicrania

• there is a unilateral facial pain
• that can resemble chronic cluster headache
• but the duration is briefer, about 15 mins,
• and it may recur many times a day even for years.

It responds specifically, sometimes dramatically, to indomethacin.

Question 4

Herpes zoster and postherpetic neuralgia

Answer 4

Herpes zoster may present as hyperaesthesia or a burning sensation

• in any division of the 5th nerve,
• esp. the ophthalmic division.

Question 5

Atypical facial pain

Answer 5

This is mainly a diagnosis of exclusion whereby pts,

• usually middle-aged women,
• complain of diffuse pain in the cheek
• unilateral or bilateral
• without demonstrable organic disease
• or which does not conform to a specific nerve distribution.

It is usually described as:

• deep-seated
• severe
• continuous
• and ‘boring’.

Treatment:

• Amitriptyline 10–75 mg nocte or
• Other appropriate antidepressant or carbamazepine