Facial Pain and the Second Edition of the International Classification of Headache Disorders


  • Karin Zebenholzer MD,

  • Christian Wöber MD,

  • Marion Vigl MD,

  • Peter Wessely MD,

  • Çiçek Wöber-Bingöl MD

  • From the Department of Neurology, Medical University of Vienna, Vienna, Austria.

Address all correspondence to Dr. Christian Wöber, Univ. Klinik für Neurologie, Währinger Gürtel 18-20, A-1090 Wien, Austria.


Background.—Recurrent or chronic facial pain may be a diagnostic challenge. Applying the diagnostic criteria of the second edition of the International Classification of Headache Disorders (ICHD-II) leaves a considerable number of patients unclassifiable.

Objective.—The aim of this study was to establish and evaluate revised criteria of trigeminal neuralgia and persistent idiopathic facial pain.

Methods.—Based on the diagnostic value of 12 clinical features of trigeminal neuralgia and 15 features of persistent idiopathic facial in 97 patients referred for facial pain to a neurological tertiary care centre we established revised criteria for persistent idiopathic facial pain and additional criteria for probable trigeminal neuralgia and probable idiopathic facial pain.

Results.—Applying the newly proposed criteria reduced the number of patients with facial pain not classifiable by more than 50%. The new criteria improved the sensitivity, particularly in idiopathic facial pain and did not cause a relevant decrease in specificity compared to ICHD-II.

Conclusion.—This study suggests that amendments to the ICHD-II criteria improve the diagnostic classification of facial pain.