Phenomena of Constant Unilateral Facial Pain With Added Attacks

face pain headache migraine neuralgia
face pain headache migraine neuralgia
Researchers posit that their study delineates distinct phenotypes of headache attacks and facial pain attacks.

Constant unilateral facial pain with distinct added attacks (CUFPA) during migraines and headaches could suggest a clinical subgroup of its own right, according to a study published in Neurology.

Researchers evaluated the prevalence of facial pain presentation using patient datasets with completed questionnaires and medical records (N=2912) from the headache and facial pain outpatient clinic at the University Medical Center Hamburg-Eppendorf. The patients had presented with primary headaches and facial involvement, specifically, involvement of the second or third trigeminal branch and patients who sought treatment exclusively for facial pain. Patients with orofacial pain who also had alveolar or dental problems were excluded from the study.

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Among patients with migraine (n=1935), 2.3% reported facial pain (n=44). Facial involvement was reported by 14.8% of patients with cluster headache (n=42/283) and by 45.0% of patients with paroxysmal hemicrania (n=9/20). Up to 6 patients presented with constant side-locked facial pain associated with facial pain attacks occurring for 10 to 30 minutes several times per day.

This study is limited by its retrospective nature and potential under-representation of facial involvement of primary headaches. Because clinical implications are lacking, facial spreading of pain may not have been mentioned by the patient or explored explicitly by the physician. The patients in this study who were described as having CUFPA could theoretically fit the criteria of persistent idiopathic facial pain, but the nature of prominent and very distinct attacks in the CUFPA cohort strongly suggest a clinical subgroup in attack length with paroxysmal headaches lacking autonomic features.

Based on these findings, researchers believe that these symptoms could be a facial pain disorder that is not yet well described or researched, and therefore propose the term CUFPA. To homogenize future research, they have proposed the following diagnostic criteria for CUFPA: mild to moderate unilateral facial pain fulfilling criterion 2; duration of >3 months; additional attacks of moderate to severe intensity fulfilling criteria 4 and 5; attack length of 10 to 30 minutes; frequency of 2 to 20 attacks per day; normal clinical neurologic examination, and pathologic cause excluded by appropriate investigation; and no better explanation by another International Classification of Orofacial Pain or International Classification of Headache Disorders diagnosis.


Ziegeler C, May A. Facial presentations of migraine, TACs, and other paroxysmal facial pain syndromes [published online August 21, 2019]. Neurology. doi: 10.1212/WNL.0000000000008124