Which initial investigations should be considered for a patient presenting with unexplained facial pain?

For a patient presenting with unexplained facial pain, initial investigations should be guided by the clinical features. If the facial pain is associated with persistent facial numbness or abnormal neurological signs, urgent neuroimaging should be considered using a suspected cancer pathway referral. This is to exclude serious underlying causes such as malignancy or neurological disease. If the facial pain is unilateral and triggered by touching the affected part of the face (suggestive of trigeminal neuralgia), referral is recommended if the pain is refractory to treatment. In cases where scalp tenderness or jaw claudication is present, which may suggest temporal arteritis, blood tests including erythrocyte sedimentation rate (ESR) should be considered, although a normal ESR does not exclude the diagnosis. These investigations help identify inflammatory causes that require urgent management. Overall, the initial approach involves clinical assessment to identify red flags and then targeted investigations such as neuroimaging and blood tests based on these findings ¹.