Diagnosis and treatment of facial pain

Abstract

Facial pain disorders are not as frequently seen as the headache, but these are similarly incapacitating to the patients. Among them, trigeminal neuralgias (TNs) are thought to be one of the worst pain disorders and the cause may be diverse. Although the neurovascular compression of the trigeminal nerve root accounts for the majority of classical TN, one may encounter with TN, secondary to tumor, demyelinating disease or others. It is imperative therefore to understand the pain mechanism of TNs for the diagnosis and appropriate treatment. Diagnostic algorithm proposed by Cruccu is useful in this regard. Ophthalmic herpes zoster and otic herpes zoster (Hunt syndrome) are followed by postherpetic neuralgia often in elderly. Early appropriate antiviral therapy is imperative and in particular, amenamevir, a helicase–primase inhibitor, appears promising for arresting the disease process. Persistent idiopathic facial pain (atypical facial pain) does not have an identifiable cause, but the patient's daily life is distressed with the ill–defined pain. One may need to assess, if there are any organic features to the pain, psychological burden and/or personality trait. If unsuccessful in controlling the pain, psychosomatic approach may be necessary.