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Central neuropathic facial pain

Ivan Garza, MD
Section Editor
Jerry W Swanson, MD, MHPE
Deputy Editor
John F Dashe, MD, PhD


By definition, "central pain" is neuropathic pain caused by a lesion or dysfunction in the central nervous system. The clinical presentation can be quite variable among patients [1]. The current International Classification of Headache Disorders recognizes two entities that are central causes of facial pain [2]:

Central neuropathic pain attributed to multiple sclerosis

Central post-stroke pain

This topic will discuss these conditions. Other causes of facial pain are reviewed elsewhere. (See "Overview of craniofacial pain".)


A lesion at any level of the central nervous system from the spinal trigeminal nucleus or spinal dorsal horn to the cerebral cortex has the potential for causing central neuropathic facial pain. There may be a higher risk for developing central pain when the spinothalamic and quintothalamic pathways are affected, compared with suprathalamic lesions [1].


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Literature review current through: Sep 2016. | This topic last updated: Oct 6, 2015.
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  1. Boivie J, Casey KL. Central pain in the face and head. In: The Headaches, Olesen, J (Eds), Lippincott Williams and Wilkins, Philadelphia 2006. p.1063.
  2. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013; 33:629.
  3. Tasker RR. Central pain states. In: Principles and Practice of Pain Medicine, Bajwa ZH (Ed), McGraw-Hill, Warfield 2004. p.394.
  4. Rowbotham MC. Mechanisms of neuropathic pain and their implications for the design of clinical trials. Neurology 2005; 65:S66.
  5. Nicholson BD. Evaluation and treatment of central pain syndromes. Neurology 2004; 62:S30.
  6. Tasker RR, Watson CPN. The treatment of central pain. In: Neurological Therapeutics: Principles and Practice, Noseworthy JH (Ed), Martin Dunitz, London 2003. p.214.
  7. Iizuka O, Hosokai Y, Mori E. Trigeminal neuralgia due to pontine infarction. Neurology 2006; 66:48.
  8. Kim JB, Yu S. Neurological picture. Trigeminal neuralgia after pontine infarction affecting the ipsilateral trigeminal nerve. J Neurol Neurosurg Psychiatry 2013; 84:881.
  9. Cranial neuralgias and central causes of facial pain. In: Mechanism and management of headache, Lance JW, Goadsby PJ (Eds), Elsevier Butterworth Heinemann, Philadelphia 2005. p.333.
  10. O'Connor AB, Schwid SR, Herrmann DN, et al. Pain associated with multiple sclerosis: systematic review and proposed classification. Pain 2008; 137:96.
  11. O'Donnell MJ, Diener HC, Sacco RL, et al. Chronic pain syndromes after ischemic stroke: PRoFESS trial. Stroke 2013; 44:1238.
  12. Manzoni GC, Torelli P. Epidemiology of typical and atypical craniofacial neuralgias. Neurol Sci 2005; 26 Suppl 2:s65.
  13. Andersen G, Vestergaard K, Ingeman-Nielsen M, Jensen TS. Incidence of central post-stroke pain. Pain 1995; 61:187.
  14. Harno H, Haapaniemi E, Putaala J, et al. Central poststroke pain in young ischemic stroke survivors in the Helsinki Young Stroke Registry. Neurology 2014; 83:1147.
  15. Frese A, Husstedt IW, Ringelstein EB, Evers S. Pharmacologic treatment of central post-stroke pain. Clin J Pain 2006; 22:252.
  16. Finnerup NB, Otto M, McQuay HJ, et al. Algorithm for neuropathic pain treatment: an evidence based proposal. Pain 2005; 118:289.
  17. Leijon G, Boivie J. Central post-stroke pain--a controlled trial of amitriptyline and carbamazepine. Pain 1989; 36:27.
  18. Vestergaard K, Andersen G, Gottrup H, et al. Lamotrigine for central poststroke pain: a randomized controlled trial. Neurology 2001; 56:184.
  19. Mulla SM, Wang L, Khokhar R, et al. Management of Central Poststroke Pain: Systematic Review of Randomized Controlled Trials. Stroke 2015; 46:2853.
  20. Crayton H, Heyman RA, Rossman HS. A multimodal approach to managing the symptoms of multiple sclerosis. Neurology 2004; 63:S12.
  21. Information on carbamazepine (marketed as Carbatrol, Equetro, Tegretol, and generics) with FDA Alerts. www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm107834.htm (Accessed on January 05, 2011).
  22. Backonja M, Glanzman RL. Gabapentin dosing for neuropathic pain: evidence from randomized, placebo-controlled clinical trials. Clin Ther 2003; 25:81.
  23. Flaster M, Meresh E, Rao M, Biller J. Central poststroke pain: current diagnosis and treatment. Top Stroke Rehabil 2013; 20:116.
  24. Taub E, Munz M, Tasker RR. Chronic electrical stimulation of the gasserian ganglion for the relief of pain in a series of 34 patients. J Neurosurg 1997; 86:197.
  25. Brown JA, Pilitsis JG. Motor cortex stimulation for central and neuropathic facial pain: a prospective study of 10 patients and observations of enhanced sensory and motor function during stimulation. Neurosurgery 2005; 56:290.