Facial pain: is this a real illness?


For many months I have been troubled by pains on the left side of my face and below my eye. Initially it was diagnosed as sinusitis, but it did not get better with several courses of antibiotics. I have had X-rays, an MRI scan and several bloods tests, all of which have come back as normal. After all this, I have been told that I have "atypical facial pain" and I have been put on a low dose of antidepressants. This is not because I am depressed - it is supposed to be treatment for the pain. I find the whole experience rather upsetting and confusing, and the pain seems no better. Is "atypical facial pain" a real illness, or am I being fobbed off?

Dr Fred Kavalier answers your health question:

Atypical facial pain is a real diagnosis, but it tends to be a diagnosis that is made when everything else has been ruled out. No one really understands what causes this type of pain. It is sometimes called chronic oral and facial pain, or persistent idiopathic facial pain. All the long words mean the same thing - pain in and around the face for which no cause can be found. Sometimes the underlying cause lies in the temporomandibular joint, where the upper end of the jaw bone connects with the skull bone just in front of the ear.

This joint can cause facial pain if it is slightly misaligned or if it becomes arthritic. Muscle tension around the face and jaw can also contribute to the pain, as can anxiety. It is also important to rule out dental problems as a cause of the pain. The use of antidepressants as a treatment for atypical facial pain is widespread and they do seem to work for some people. A low dose of an antidepressant is often effective in relieving the pain and breaking the cycle of pain and anxiety.

Please mail your questions for Dr Fred to health@independent.co.uk. He regrets that he is unable to respond personally to questions.

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