Overview

What is atypical facial pain?

Atypical facial pain (AFP) is chronic pain in your face or mouth that doesn’t have a clear cause. It’s also called persistent idiopathic facial pain (PIFP). AFP can affect any area of your face, but it often causes jaw, ear or cheek pain. The condition can be difficult to diagnose and can be frustrating if you’re experiencing pain.

Who gets atypical facial pain?

Anyone can get AFP, but it tends to be more common in women who are in their 40s or 50s. People who have had dental injuries or mouth surgery in the past may be more likely to get AFP.

How common is atypical facial pain?

AFP isn’t common. It affects less than 1% of the population. But this number may be higher since AFP is often misdiagnosed. Its symptoms may be the same as many other face and mouth conditions such as trigeminal neuralgia.

Symptoms and Causes

What causes atypical facial pain?

AFP doesn’t have a known cause. It may have a link to psychological issues. Chemicals in your brain called neurotransmitters regulate your mood and how you perceive pain. Depression, anxiety or other mental health disorders disrupt the way neurotransmitters work. They may change the way we feel pain or make us more sensitive to it.

What are the symptoms of atypical facial pain?

People with AFP have pain in their face every day for at least three months. Heat, cold or touch may trigger the pain. Some people also report that the pain gets worse if they’re tired or stressed.

The pain may be on the left or right side of your face, often near the jaw or ear. It might feel contained to one small area of your face, or it might spread over your whole face. It doesn’t follow the path of a nerve.

Someone with AFP may describe the pain as:

Burning.
Deep.
Dull or aching, but with periods of a sharp, stabbing sensation.
Pounding or throbbing.
Tingling, or having a pins-and-needles feeling.

Do people with atypical facial pain tend to have other health problems?

It’s common for people with atypical facial pain to also have:

Depression, anxiety or mood disorders.
Irritable bowel syndrome (IBS).
Unexplained pain in other areas of their body.

Diagnosis and Tests

How is atypical facial pain diagnosed?

Atypical facial pain is difficult to diagnose. The symptoms are similar to those of many other facial pain syndromes. Your healthcare provider will do a physical exam, review your medical history and evaluate your symptoms.

Your healthcare provider may perform tests to rule out other conditions that could make your face hurt. They call this a differential diagnosis.

Tests may include:

Dental exams: A dentist carefully examines your teeth, jaws and the inside of your mouth. They may do dental X-rays to check for cavities, infections, impacted molars or other dental problems.
Imaging exams: An MRI or CT scan can detect problems in your head, neck or face. Your healthcare provider may do these tests to rule out the possibility of a facial fracture, tumor or blood vessel problem.
Neurological tests: Your healthcare provider uses neurological testing to check the nerves in your face. They may ask you to blink and move your eyes in different directions. They check your ability to smile, frown and move your lips. They may also touch different areas of your face to check for pain or numbness.
Psychological tests: Your healthcare provider may ask questions about your mood, behavior and interactions with other people. Problems like depression, stress or anxiety may trigger pain or make it worse.

What other conditions cause facial pain?

Your healthcare provider needs to rule out many other possible causes of facial pain. Atypical facial pain is not caused by the following conditions:

Blood vessel disorders such as temporal arteritis (blood vessel inflammation near your temples).
Chronic sinusitis.
Dental diseases.
Headaches.
Myofascial pain syndrome (pain deep in your muscles).
Nasopharyngeal carcinoma (cancer that affects the nose and throat).
Temporomandibular disorders (jaw problems).
Trauma or face fractures.
Trigeminal neuralgia (pressure on a nerve in the brain).

Management and Treatment

How is atypical facial pain treated?

AFP can be difficult to treat since the underlying cause isn’t known. Your healthcare provider may recommend a combination of therapy and medication:

Cognitive-behavioral therapy (CBT): CBT is a psychological treatment that can help people with chronic pain. You learn to identify and avoid triggers of pain. You also learn coping strategies, such as deep breathing, for managing pain.
Medication: Antidepressants may help people who have pain related to depression. Your healthcare provider may recommend tricyclic antidepressants or selective norepinephrine reuptake inhibitors (SSRIs). Anticonvulsants (drugs to treat seizures) may also help regulate nerve impulses that trigger pain.

Can alternative therapies help atypical facial pain?

You may consider talking to your healthcare provider about alternative therapies for AFP. Alternative, or complementary, therapies are treatments that aren’t part of traditional Western medicine. Alternative therapies that may help relieve chronic pain include:

Prevention

How can I prevent atypical facial pain?

There’s no way to prevent AFP. But therapy may help you identify and avoid activities or situations that trigger pain.

Outlook / Prognosis

What is the outlook for atypical facial pain?

Chronic pain may eventually go away on its own. Many people with AFP respond well to medication, psychotherapy or alternative therapies. But some people manage facial pain for the rest of their lives.

Living With

How can I make living with atypical facial pain easier?

AFP can be a stressful, frustrating condition. Even though AFP doesn’t have a clear cause, the pain is very real. The first step in learning to cope with the pain is to talk with your healthcare provider about what you’re experiencing. They may refer you to other healthcare providers who can help, such as:

Dentists.
Neurologists.
Pain management doctors.
Psychiatrists or psychologists.

Other ways to cope with AFP include:

Join a support group.
Reduce the stress in your life.
Stay active and engaged with others.

When should I call a doctor?

Seek immediate medical attention if your face pain suddenly worsens or you experience any of the following symptoms:

Chest pain.
Dizziness.
Shortness of breath.
Swelling in the face, head or neck.
Trouble seeing.

A note from Cleveland Clinic

Atypical facial pain (AFP) is persistent pain in your face that doesn’t have a known cause. Most people with AFP have pain every day for at least three months. A healthcare provider will perform a variety of diagnostic tests to rule out other conditions that could be causing your face pain. The most common treatments for AFP include medication and psychotherapy.

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Atypical Face Pain