Atypical facial pain was first described by Temple Fay in 1927 as a vascular syndrome of dull, throbbing pain situated deep in the eye and malar region often referred toward the ear, lateral neck, and shoulders. When this syndrome is encountered in medical practice it is often perplexing to the physician and frustrating to the patient. A systematic approach to this problem will aid in the diagnosis and possible treatment which may be facilitated by a thorough understanding of the anatomic pathways involved in various types of acute and chronic facial pain. Diagnostic techniques and therapeutic modalities will also be reviewed.