Reference Work Entry

Handbook of Headache

pp 505-513

Persistent Idiopathic Facial Pain

  • Rigmor JensenAffiliated withDanish Headache Centre and Department of Neurology, Glostrup Hospital, University of Copenhagen Email author 
  • , Dimos D. MitsikostasAffiliated withNeurology Department, Athens Naval Hospital
  • , Christian WöberAffiliated withDepartment of Neurology, Medical University of Vienna


Persistent Idiopathic Facial Pain (PIFP) is a moderate or severe continuous pain disorder in the facial region. The pain is usually deep and poorly localized, and the quality is of burning, cramping, or dull quality. The incidence is estimated to 2–4 per 100,000 but exact epidemiological data are lacking. Persistent idiopathic facial pain is a difficult diagnostic group compared to other pain categories and symptomatic causes must always be sought. The underlying pathophysiology is yet unknown and therapy is widely unspecific and ineffective. The existing literature is reviewed and summarized, the possible differential diagnoses are listed, and the existing treatment strategies are presented. The optimal outcome is achieved by a multidisciplinary approach focusing on a combination of symptomatic medication, patient education, cognitive therapy, and coping strategies. In conclusion, patients with PIFP remain a complicated group to diagnose and to treat. The scientific evidence for a specific entity, a clear pathophysiological mechanism and effective treatment strategies are still lacking. Further field testing and clinical characterizations of these severely affected patients are highly needed and the noncommittal title Persistent Idiopathic Facial Pain is preferable until further evidence is available.