Pain in the Face

Abstract

Facial pain is a common symptom in the neurological clinic and presents interesting and difficult diagnostic problems. The remittent paroxysmal pain of trigeminal neuralgia is the best-defined of all the syndromes encountered in this connexion. It is a disease of the elderly, shows considerable remissions, is unassociated with any abnormal physical signs, and always recurs. About three-quarters of all cases can be effectively relieved by Tegretol (carbamazepine), and in the remainder surgical section of the sensory root of the nerve remains the treatment of choice. Post-herpetic neuralgia on the other hand shows little response to surgery but a marked tendency to spontaneous recovery, and is best treated by powerful analgesics, including heroin in severe cases. Migrainous neuralgia or “ cluster headache ” is a well-defined syndrome of unilateral first-division pain, remarkably responsive to ergotamine, but often unrecognized. Among structural causes of facial pain temporomandibular arthritis, nasopharyngeal cancer, and intracranial aneurysm should be remembered. It may also be a symptom of agitated depression and may respond to antidepressive drugs. There remains a considerable group of cases of distressing facial pain which lack the clear-cut characteristics of any of the forms described above, occur almost exclusively in middle-aged women, and resist every form of treatment but sometimes clear spontaneously. © 1968, British Medical Journal Publishing Group. All rights reserved.