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Chronic pain in the facial area is a very complex symptom which always which always gives doctors headaches when they need to make the right diagnosis. Anything can trigger this pain, from surgical interventions to stressful situations, but no one really knows what the mechanism of its development and progression is. The most common cause of one-sided facial pain is trigeminal neuralgia, but there are also cases with an unrecognized cause classified as persistent idiopathic facial pain (PIFP). Here is more information about these conditions.

Trigeminal Neuralgia

The most common cause of the chronic pain in the facial area is so called trigeminal neuralgia, which occurs due to compression of the trigeminal nerve right after it leaves the brain. The trigeminal nerve is one of the largest cranial nerves, and among other functions, it also innervates the middle region of the face on the same side of the body. The highest percentage of the facial surface is under control of this nerve. Some of the blood vessels which supply the brain with blood (cerebral arteries), can become distorted and apply pressure to the trigeminal nerve.

This causes stimulation of the nerve and consequent sensations, which patients often report as a severe pain or pressure-like sensation, usually on one side of the face. The pain can be triggered by brushing the teeth or even touching the face. It is one of the most painful conditions in medicine.

Standard treatment choices for trigeminal neuralgia include anticonvulsive drugs and antidepressants. If medication therapy is unsuccessful, neurosurgical procedures can be performed in order to lower the pressure to the nerve. More and more people today are turning to alternative medicine to help them with this problem. Some evidence shows that medication and acupuncture may have success in relieving the symptoms of trigeminal neuralgia.

Persistent Idiopathic Facial Pain (PIFP)

This is a relatively newly defined clinical entity which encompasses those cases of chronic facial pain that do not fulfill the criteria for neuralgic pain. The onset of PIFP is usually triggered by some surgical intervention, tooth extraction, etc., but the actual cause has not yet been identified.

PIFP usually manifests as pain or pressure, localized on one side of the face, and without other associated symptoms. It most commonly affects the lips and the area around the mandible. Later in the course of the disease, the pain may spread to the whole side of the face, neck, and even arm. Sometimes, the pain can appear on the other side of the face too.

It is very frustrating for both patients and scientists that neither cause nor the exact patterns of manifestation have been established for PIFP. The diagnostic process takes a very long time, because the diagnosis is usually made by exclusion of any other condition that could possibly cause facial pain. Electromyoneurography (EMNG) is the most important test for the assessment of the possible disturbances in neuromuscular transmission.

Luckily, there are treatment options which can help these patients relieve their symptoms. The medications used for PIFP include anticonvulsive drugs, antidepressants, and opioid analgesics. Although these drugs can help with the symptoms, they can also affect the quality of life because of their effects on the central nervous system.

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