Chronic mid-facial segment pain

Background: Chronic Mid-facial segment pain is a common cause of facial pain. It is thought to be responsible for around 1/3^rd of patients referred to secondary care with “sinusitis”. It causes pain anywhere in a band distribution in the middle segment of the face. It typically involves a dull, ache over the bridge of the nose, retro-orbital pain, dental pain or cheek pain. It usually occurs bilaterally and can be constant. There may be tenderness on palpation. It can give the sensation of nasal obstruction and so is often confused with sinusitis. It has been linked to tension headache.

How to manage:

Lifestyle advice – good hydration, good sleep quality, wear glasses / get eyes checked, stress management

Amitriptyline can be trialled – commence at lowest dose for initial therapy and titrate up as needed

Referral guidance:

Consider referral to ENT on a routine basis to exclude sinogenic origin for pain