https://doi.org/10.4081/cc.2024.15773

Persistent idiopathic facial pain, a challenging diagnostic entity: clinical series from a third-level headache center

Vol. 34 No. 2 (2024)
Submitted: 27 July 2024
Accepted: 17 December 2024
Published: 10 January 2025
Persistent idiopathic facial pain, trigeminal neuralgia, neuropathic pain
Abstract Views: 38
PDF: 20
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Authors

Danilo Antonio Montisano
https://orcid.org/0000-0003-4834-2045
Neurology Unit and Headache Center, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
Alberto Raggi
https://orcid.org/0000-0002-7433-7779
SC Neurologia, Salute Pubblica e Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
Marina De Tommaso
Brain Department, Neurophysiopathology Unit, Bari Aldo Moro University, Italy.
Licia Grazzi
licia.grazzi@istituto-besta.it
Neurology Unit and Headache Center, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.

Background: Persistent idiopathic facial pain (PIFP) is a rare and disabling disease, often misdiagnosed. In this paper, we describe clinical phenotypes and histories of our patients with PIFP.

Methods: Clinical information about pain, treatment histories, previous diagnoses, and MRI findings were assessed during the visit and collected retrospectively.

Results: We observed a total of 44 females and 19 males, with a median age of 63 years. The patients had previously received diagnoses of trigeminal neuralgia, short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT), and migraine, and some had a diagnosis of PIFP. The quality of pain was described mostly as continuous, stabbing, or burning. The distribution of the pain was referred to as the trigeminal territory, mostly with a second-third branch distribution. Eighteen patients underwent dentistry procedures before the pain started. Pregabalin and carbamazepine were the most frequently prescribed treatment. In 18 patients, a neurovascular conflict was found, and all underwent invasive procedures with poor outcomes.

Conclusions: PIFP is a challenging orofacial pain entity, often misdiagnosed. Knowledge of the disease is the first step toward better management. A methodological and systemic approach like that applied to neuropathic pain would be suitable. We suggest a multidisciplinary approach, including medications combined with non-pharmacological options.

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How to Cite

1.
Montisano DA, Raggi A, De Tommaso M, Grazzi L. Persistent idiopathic facial pain, a challenging diagnostic entity: clinical series from a third-level headache center. Confinia Cephalal [Internet]. 2025 Jan. 10 [cited 2025 Jan. 22];34(2). Available from: https://www.confiniacephalalgica.com/site/article/view/15773
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