Persistent idiopathic facial pain associated with borderline personality disorder: a case report




Cognitive behavioral therapy, Facial pain, Borderline personality disorder, Lithium carbonate, Venlafaxine hydrochloride


Borderline personality disorder may be associated with persistent facial pain since its relationship with different pain syndromes has been reported. Persistent idiopathic facial pain is commonly unilateral, pulsating, burning, or profound and challenging for clinicians. Therefore, excluding underlying organic causes by appropriate clinical investigation and complementary tests is essential to diagnose this disease.
This case report aimed to provide evidence of the relationship between idiopathic persistent facial pain and borderline personality disorder.
Case report 
A 24-year-old woman reported severe pain in the left hemiface for ten months, three to six hours per day, five days per week. No abnormalities were found in dental and neurological assessments. A psychiatric evaluation was performed, and the patient met the criteria for borderline personality disorder. Pharmacological treatment consisted of daily lithium carbonate (900 mg) and venlafaxine (150 mg). Weekly sessions of cognitive-behavioral therapy with emotional regulation and tolerance to stress were performed. The patient was evaluated every 30 days and showed improved pain intensity and frequency over six months. 
Proper management of borderline personality disorder can modify the evolution of persistent idiopathic facial pain when both pathologies are comorbidities.


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Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia 2018;38(1):1-211 Doi: 10.1177/0333102417738202 DOI:

Borges RdS, Kraychete DC, Borges ELG and Melo VMd. Persistent idiopathic facial pain, a diagnosis and treatment of challenge. Case report. BrJP 2018;1(3):279-282 Doi: 10.5935/2595-0118.20180053 DOI:

Christofolleti LM, Oliveira MdFV and Siqueira SRDTd. Personality, coping and atypical facial pain. Case reports. BrJP 2018;1(1):77-79 Doi: 10.5935/2595-0118.20180016 DOI:

Millon T. Teorias da psicopatologia e personalidade: ensaios e críticas. 2 ed. Rio de Janeiro: Editora Interamericana; 1979. p. 360.

Louzã MR and Cordás TA. Transtornos da Personalidade. 2.ed. Porto Alegre: Artmed Editora; 2019. p. 216.

Sansone RA and Sansone LA. Chronic pain syndromes and borderline personality. Innov Clin Neurosci 2012;9(1):10-14

Martins H. Is borderline personality disorder the cause of chronic headache? Av em Med 2021;1(1):75-76 Doi: 10.52329/AvanMed.15 DOI:

Martins H, Martins B, Martins B, Ribas V and Santos A. Borderline and Antisocial Personality Disorders in the Bible. J Psychol Psychother Res 2021;8(1):11-21 Doi: 10.12974/2313-1047.2021.08.2 DOI:

Tragesser SL, Bruns D and Disorbio JM. Borderline personality disorder features and pain: the mediating role of negative affect in a pain patient sample. Clin J Pain 2010;26(4):348-353 Doi: 10.1097/AJP.0b013e3181cd1710 DOI:

Frankenburg FR and Zanarini MC. The association between borderline personality disorder and chronic medical illnesses, poor health-related lifestyle choices, and costly forms of health care utilization. J Clin Psychiatry 2004;65(12):1660-1665 Doi: 10.4088/jcp.v65n1211 DOI:

Harper RG. Personality-guided therapy in behavioral medicine. Personality-guided therapy in behavioral medicine. Washington, DC, US: American Psychological Association; 2004. p. 359. DOI:

Perez-Rodriguez MM, Bulbena-Cabré A, Bassir Nia A, Zipursky G, Goodman M and New AS. The Neurobiology of Borderline Personality Disorder. Psychiatr Clin North Am 2018;41(4):633-650 Doi: 10.1016/j.psc.2018.07.012 DOI:

Feinmann C. Psychogenic facial pain: Presentation and treatment. J Psychosomatic 1983;27(5):403-410 Doi: 10.1016/0022-3999(83)90076-4 DOI:

Beatson J and Rao S. Depression and borderline personality disorder. Med J of Australia 2012;197(11):620-621 Doi: 10.5694/mja12.11646 DOI:

Bulbena-Cabre A, Perez-Rodriguez MM, Porges S, Bulbena A and Goodman M. Understanding Anxiety in Borderline Personality Disorder. Curr Treat Options Psych 2017;4(2):281-294 Doi: 10.1007/s40501-017-0122-0 DOI:

Beblo T, Mensebach C, Wingenfeld K, Rullkoetter N, Schlosser N and Driessen M. Subjective memory complaints and memory performance in patients with borderline personality disorder. BMC Psychiatry 2014;14(1):Doi: 10.1186/s12888-014-0255-2 DOI:

Sansone RA and Sansone LA. Borderline personality and the pain paradox. Psychiatry (Edgmont) 2007;4(4):40-46

Berghöfer A. Lithium and suicide. Bmj 2013;347(f4449) Doi:10.1136/bmj.f4449 DOI:

Benard V, Vaiva G, Masson M and Geoffroy PA. Lithium and suicide prevention in bipolar disorder. Encephale 2016;42(3):234-241 Doi: 10.1016/j.encep.2016.02.006 DOI:




How to Cite

Martins HA de L, Martins BBM, Santos CC dos, Pontes DJ, Oliveira DA de, Valença MM. Persistent idiopathic facial pain associated with borderline personality disorder: a case report. Headache Med [Internet]. 2021 Aug. 27 [cited 2024 Apr. 15];12(1):59-63. Available from:



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