[Patient careers. Facial pain and neuralgias].

The correct diagnosis in patients with facial pain is essential to avoid erroneous diagnostic and therapeutic measures. Trigeminal neuralgia is easily recognized by the typical history given by the patient. Treatment of first choice is carbamazepine. When pharmacological treatment fails, surgical options are available. Tolosa Hunt syndrome is judged to be caused by a granulomatous infiltration in the cavernous sinus, treatment consists in corticosteroids. Painful craniomandibular disorders are often mistaken for 'atypical facial pain'. Atypical facial pain, now called 'persistent idiopathic facial pain' should only be diagnosed after thorough exclusion of all known primary and symptomatic facial pain syndromes. Treatment consists mainly in patient education, in the avoidance of further surgical interventions, and in pharmacotherapy with tricyclic antidepressants. A thorough history and examination are crucial to correctly classify these facial pain syndromes.