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.