Definition and Overview

Facial pain is a sudden, very painful sensation in the face. Most patients describe this pain as very similar to an electric shock, sharp and stinging, or sometimes a distracting, throbbing pain that lasts for longer periods. Facial pain that does not subside after three months and is not caused by injury or infection is considered a chronic condition.

Facial pain can be very devastating to the patient, not only because of the pain, but also because it hinders productivity and enjoyment in day-to-day life. Patients often report that they fail to enjoy normally pleasurable activities, cannot sleep peacefully, feel down, find it hard to participate in social situations, and feel very apprehensive and anxious about the pain they are experiencing.

Cause of Condition

There are many conditions that can cause chronic facial pain. Below are the most common.

  • Trigeminal neuralgia. One of the more recognized causes of facial pain, this is a condition wherein the trigeminal nerves (located on both sides of the face) or its branches are compressed by a blood vessel. In this condition, the nerve’s outer membrane, known as the myelin sheath, is damaged and thus malfunctions in transmitting pain signals to the brain. Trigeminal neuralgia is common among older patients, with more women suffering from the condition than their male counterparts.

  • Abscessed tooth. Dental problems are among the most common causes of facial pain. When there are teeth problems, the level of pain can range from severe, sharp sensations to a dull throb or ache that persists for hours. Some patients report experiencing serious facial pain whenever they are eating, or when consuming very cold, very hot, or very sweet foods. Pressure on the teeth can also cause facial pain in some patients.

  • Sinus inflammation. This can be related to dental problems, especially when the patient is also experiencing fever, fatigue, and discharge from the nose.

  • TMJ or temporomandibular disorder. Patients suffering from this condition typically experience pain in the jaws or where the jaws are hinged together. The pain experienced can be sharp and severe yet intermittent, but can also be a constant dull throbbing in the jaw, behind the ears, or in the neck. TMJ pains are often felt when the jaws are moved or when chewing.

  • Other types of neuralgia. In patients who have recently suffered from shingles, pain can be experienced around the eyes or forehead, and can be coupled with tenderness in those regions.

  • Cluster headaches. The arteries inside the skull are dilated and cause pain on one side of the head. The cluster tic syndrome can also be another cause of facial pain, especially when the patient feels sharp stabbing sensations, constant throbbing, and other kinds of pain at the same time.

  • Facial migraine. This is very similar to normal migraines, but occurs in the teeth, gums, nostrils, and cheeks. This can also be accompanied by an increased sensitivity to light and noise.

To determine the cause of facial pain, the patient must consult with a doctor who will order a round of tests to eliminate one possible cause after the other to arrive at an accurate diagnosis.

Key Symptoms

Facial pain caused by trigeminal neuralgia exhibits a variety of symptoms. Pain is usually contained on one side of the face, with the right side being more common among patients (though there are some rare cases where patients experience pain in both sides of the face, which means that both trigeminal nerves are affected). Patients often describe the pain as sharp and stabbing, resembles an electric shock to the face, shooting, or like something is cutting through their faces. In the case of trigeminal neuralgia, the pain can be fairly mild and short-lived, or constant and excruciating.

Tooth- or sinus-related causes of facial pain are typically accompanied by symptoms isolated in the affected areas, such as the nose, gums, teeth, and cheeks. The pain can be sharp or more of a dull throb that persists for hours. TMJ disorders, on the other hand, have symptoms isolated to the jaw, ears, or even the neck.

Who to See and Types of Treatment Available

When experiencing facial pain, it is best to consult with a general practitioner first who can order tests to determine the root cause of the pain.

For those who suffer from trigeminal neuralgia, the doctor can prescribe anti-epilepsy medication to treat the symptoms. These drugs are also known as anticonvulsants, and are useful in decreasing the activity of the nerves. When the trigeminal nerves respond to the medication, they stop sending pain signals to the brain and thus the patient experiences relief. However, it is important to note that epilepsy medication does not completely cure the condition and only reduces the amount of pain the patient is experiencing. Some doctors are hesitant to prescribe anticonvulsants to patients, as they are known to cause severe tiredness, drowsiness, and impaired focus.

Surgery can also be a treatment method for patients whose symptoms are not effectively managed by medication. Research shows that trigeminal neuralgia is best treated with surgery when caught early. A neurosurgeon will perform the procedure with the help of a pain specialist. In a surgical procedure, the neurosurgeon can choose to interrupt the nerve and block the pain signals, but this can also result in numbness or loss of sensation in the target area. Stereotactic radiosurgery can also be an ideal surgical option. This non-invasive procedure uses radiation directed at the trigeminal nerve to interrupt the neural activity of the affected nerves.

References:

  • Digre KB. Headaches and other head pain. In: Goldman L, Ausiello D, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 405.

  • Bartleson JD, Black DF, Swanson JW. Cranial and facial pain. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley’s Neurology in Clinical Practice. 6th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 18.

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