Facial Pain

A 47-year old female patient was referred to the Nasal Disorders clinic to investigate her for persistent facial pain. A provisional diagnosis of chronic rhinosinusitis was made and the patient had a course of intranasal corticosteroids without any encouraging results. She described the pain mainly as a feeling of pressure and discomfort over the nasal bridge, nasion and periorbital regions. There was no history of migraines or headaches, the patient described intermittent nasal obstruction but had no other concerns. Flexible nasendoscopy and CT scan of the sinuses were normal, without any signs of chronic inflammation or any other sinonasal pathology. After excluding other causes of headaches and facial pain, the diagnosis of midfacial segment pain was made and the patient was started on Amitriptyline 10 mg once daily at night. This improved her symptoms and no further actions were taken apart from monitoring the effect of medical treatment and the need for dose adjustment.