Medication Overuse Facial Pain - MOFP: a case series and proposed diagnostic criteria

Persistent idiopathic or chronic atypical facial pain (AFP) is a poorly defined syndrome. Patients with facial pain are often given this diagnosis after other causes had been excluded, It is therefore likely to encompass a variety of conditions. We present a case series of seven patients with facial pain of unknown cause, after clinical assessment and investigations. The common factor in this group of patients was overuse of large doses of strong analgesics or triptans. Medication withdrawal was associated with significant reduction in severity and frequency of facial pain. We propose the syndrome of Medication Overuse Facial Pain as a cause of atypical facial pain in some patients. This condition appears to be analogous to Medication Overuse Headache. Identification and medication withdrawal appear to be the key for managing these patients. Conclusion: We have identified medication overuse as an important feature in some patients with atypical facial pain. A thorough history of medication overuse should be specifically taken, as withdrawal can lead to pain relief.