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The aim of the study was to evaluate facial pain clinically and to determine the frequency with which structural lesions were diagnosed by means of magnetic resonance imaging in a sample of patients with facial pain, including refractory trigeminal neuralgia and atypical facial pain. Fifty-two patients with facial pain were examined clinically, and treatment protocols were adopted for trigeminal neuralgia and atypical facial pain. The patients with atypical symptoms and those who did not to respond to the treatment underwent magnetic resonance imaging to screen for intracranial lesions. Magnetic resonance images of 38 patients were obtained. The female-to-male ratio of the patient population was 32:20. The mean age of the patients was 57.15 ± 11.49 years. Intracranial lesions were diagnosed in 24 patients. Ten patients had no intracranial pathoses visible on magnetic resonance images. Four patients had other pathoses that were not related to the facial pain. The most frequently observed extracranial pathologic change was sinusitis.It may not be possible to reliably identify high-risk patients for selective magnetic resonance imaging on the basis of a clinical evaluation alone. Routine magnetic resonance imaging for all patients with facial pain is recommended to exclude intracranial lesions.