Atypical Facial Pain

[Sam]

I’ve had Atypical Facial Pain for 3 years. No cause found. I suffer from non stop pain on right side of face all the time and the other side sometimes too. J keep trying treatments but it really bothers me that no one can diagnose constant swelling in the chin. The suffering is getting worse. Dr wants to try ketamine. Not sure about that

[virtualheadachespecialist]

Hello Sam, our apologies for the delay. There had been a glitch where we had not been alerted to new messages on the discussion board with one of the last site updates. Atypical facial pain can be a tricky diagnosis and is often hard to manage. Management begins with the proper evaluations, which include a brain MRI with and without contrast and brain MRA without contrast. The MRI should include a trigeminal neuralgia protocol to include focused in views of the trigeminal nerves. This includes IAC/CPA views, CISS sequences, and it is typically all included if it is written to be done with a trigeminal neuralgia protocol.

If there are sharp electrical zaps on top of a background continuous pain (or if not a continuous background pain), trigeminal neuralgia is possible. If there are features of one sided eye tearing, redness, droopiness, one sided nose running or congestion, then a type of trigeminal autonomic cephalalgia should also be considered.

The bottom line is that it is hard to say much further without a discussion of the specific location of pain, character of pain, pattern of pain, associated features, and neurologic exam.

Many times a cause may not be found. So it is a matter of finding the right medication to suppress the irritability of the trigeminal nerves which innervate the sensation of the face.

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