Atypical Facial Pain and Depression

Prolonged facial pain has long been a source of frustration to the medical profession, both from the diagnostic and therapeutic standpoints. The difficulty arises not in the “typical” facial pain syndromes such as trigeminal neuralgia, migrainous neuralgia or post-herpetic neuralgia, nor with pain due to diseases of the teeth, throat, nose, eyes and ears, but in the deep, poorly localized vaguely described pain which does not adhere to a strict anatomical distribution. The latter symptom complex has been given many names, but in spite of this is a remarkably uniform syndrome. It is characterized by pain that is felt deep in the soft tissues or the bone, rather than in the superficial tissues as occurs so often in the typical neuralgias, is poorly localized and vaguely described. The pain may be felt in regions supplied by the fifth and ninth cranial nerves and the second and third cervical nerves. Its distribution does not conform to the peripheral distribution of these nerves, but may involve portions of the sensory supply of two or more of them and may cross the mid-line. In general the pain is constant and endures for long periods of weeks to years. It is unusual to find trigger zones or clear-cut precipitating factors, and the pain is rarely excruciating.