Facial pain: After the dentist and ENT have finished

A 63-year-old woman is referred for neurologic consultation because of electrical shocks of pain in a left V3 distribution. The attacks are very brief, but occur many times a day, triggered by cold, touch, and chewing. In between attacks, she is pain free. Her neurologic examination is normal. This straightforward presentation of trigeminal neuralgia leaves the consulting neurologist wondering what to do with the other 45 minutes of the visit. The current article is vignette-based and deals with patients who may not fit into such a neat category. It is meant for the general neurologist, not the headache specialist. Aside from routine scenarios, it includes discussions of atypical facial pain, temporomandibular joint disorder, burning mouth syndrome, and other vexing types of facial pain.