Facial pain: types, causes and what helps?

What is facial pain?

Facial pain is acute, recurrent or persistent pain in the face. These can affect the entire face or just specific areas such as the mouth, ears, forehead or around the eyes. The pain occurs either on one or both halves of the face and sometimes radiates to neighboring parts of the body such as the shoulders. Depending on the cause, the facial pain can also feel tingling, stabbing or dull and oppressive.

Possible causes of facial pain

There can be a variety of causes behind facial pain. For example:

• Inflammation of the paranasal sinuses : Paranasal sinuses usually become inflamed as a result of a cold . Pressure pain in the forehead, cheeks or around the eyes is typical.
• Diseases of the teeth or the temporomandibular joint: Facial pain is also possible in the case of gingivitis , a wedged wisdom tooth or unconscious grinding of the teeth . Some people also suffer from a dysfunction of the masticatory system called craniomandibular dysfunction ( TMD).
• Nervous system disorders: Inflammation or damage to the central nervous system (CNS), such as in a stroke , can also cause facial pain.
• Fascial migraines and headaches : About 2.3 percent of people who have migraines suffer from the special form called fascial migraines. And also in those affected by cluster headaches, in 14.8 percent of the cases, the pain is predominantly localized to the facial area (fascial cluster headache ).
• Eye disorders: Inflammation of the iris or optic nerve and acute ocular hypertension can also be associated with facial pain.
• Viral diseases: In the case of shingles on the face (facial erysipelas), nerve nodes are affected. In addition to skin changes with blisters and pustules, severe pain is also typical.
• Salivary stones (sialolithiasis): Established salivary stones that prevent salivary drainage, as well as bacterial infections of the salivary glands, are also often expressed as pain in the mouth area.
• Injuries to the face: Beatings or bumps on the neck and face can cause painful injuries.
• Angina pectoris (chest tightness): A reduced supply of oxygen to the heart is expressed primarily by a feeling of pressure in the chest area. However, pain can also radiate into the lower jaw.

Trigeminal neuralgia as a cause of facial pain

The most common cause of facial pain is trigeminal neuralgia. The typical facial pain can be assigned to the trigeminal nerve (Nervus trigeminalus), the fifth of the twelve cranial nerves. With its three branches, it supplies important areas of the face.

Typical is a suddenly shooting, very severe, one-sided pain. It usually occurs very suddenly, the attacks usually last only a few seconds. Possible triggers for pain attacks are, for example, touching the face, brushing your teeth or a cold draft.

Persistent idiopathic facial pain

Clear causes cannot always be identified for facial pain. In this case, experts speak of persistent idiopathic facial pain (PIFP). The term atypical facial pain used to be used to differentiate it from typical attack-like trigeminal neuralgia. In over 90 percent of cases, those affected suffer from constant pain with constant or changing intensity that cannot be assigned to any nerve or muscle.

Symptoms of persistent idiopathic facial pain:

• Pain is present daily and usually for most of the day
• Complaints are mostly unilateral
• Pain is described as nagging and dull
• Sensory disturbances or other neurological deficits are not present

Examinations such as X-rays of the face and jaw remain unremarkable in idiopathic facial pain. It is therefore a diagnosis of exclusion. With a proportion of 70 to 90 percent, women in particular are often affected. The symptoms mainly appear between the ages of 30 and 50 and often after an operation (usually a dental procedure). Few data are available on frequency. However, experts assume that atypical facial pain is rather rare.

When should facial pain be clarified by a doctor?

A doctor should be consulted in any case if the facial pain:

• are very strong
• occur over a longer period of time
• always return

The first point of contact is usually the family doctor’s practice. However, the family doctor may refer those affected to specialists in neurology, orthopaedics, orthodontics, psychology or internal medicine. The dentist is another option for facial pain.

Diagnosis of facial pain

In the case of facial pain, the doctor will first question the person concerned in detail. For example, the following questions are of interest:

• Where is the pain located exactly?
• When do the complaints appear?
• Is the pain constant?
• How does the pain feel?
• Are there other symptoms?

This is usually followed by a detailed examination of the face, during which the sensitivity to pressure is assessed. The scalp, neck, lymph nodes and salivary glands are also usually examined. In addition, blood tests to determine inflammation or imaging methods such as computed tomography ( CT ) of the head can be used.

In the case of dental problems, patients are referred to a dental practice, where the jaw and teeth are examined in more detail. If there is a suspicion of a serious illness such as trigeminal neuralgia, eye inflammation or tumors, you will be referred to a hospital or a specialist for further diagnostics.

Therapy: How is facial pain treated?

Treatment for facial pain depends on the underlying cause. In the case of persistent idiopathic facial pain, if the dental status is healthy, further dental surgical interventions should be avoided in order to prevent the pain from spreading. In the case of diseases of the teeth or the periodontium, it is important to weigh up the advantages and disadvantages in detail.

To relieve the persistent pain – as with nerve pain (neuralgia) – tricyclic antidepressants can be prescribed, which also work well for tension headaches . Antispasmodic drugs (anticonvulsants) and painkillers such as opioids can also be useful. In addition to drug therapy, it is also possible in some cases to treat facial pain through surgical interventions. Then it is advisable to consult several experts.

A stay in a pain clinic also helps some sufferers. Facial pain can be associated with severe psychological strain and have a significant impact on everyday life. It is all the more important that patients learn to deal with the pain better, for example with the help of behavioral therapy measures. Relaxation exercises can help reduce stress.

Description: Facial pain is acute, recurring or persistent pain in the face that can feel dull, burning or tingling

Causes: Often sinusitis , diseases of the dental apparatus or nerve pain such as trigeminal neuralgia; less often fascial migraine or cluster headache, eye diseases, viral diseases, injuries, salivary stones, persistent idiopathic facial pain

Diagnosis: medical history , physical examination, imaging procedures; visits to various specialists are often necessary