Facial pain occurs in many people, and can have a variety of causes. Some causes for facial pain include migraine headaches, dental problems, temperomandibular joint (TMJ) dysfunction, and neuropathic facial pain.
A common, intense, neuropathic pain in the face is called trigeminal neuralgia. The trigeminal nerve is the fifth cranial nerve, and is responsible for communicating sensory information to the brain. Trigeminal neuralgia is an inflammation of the trigeminal nerve, and may be triggered by multiple every day activities like eating, or brushing the teeth. The trigeminal nerve has three branches, affecting three different aspects of the face. Any one of these branches can be the culprit. Identifying the correct nerve is vital to establishing an effective treatment plan.
The sphenopalatine ganglion can cause another kind of pain. It sits directly behind the nose, and may be implicated in pain that occurs primarily in the front of the face. Many headaches are caused by irritation of the sphenopalatine ganglia.
Neuropathic facial pain originates from the occipital nerves in a condition called occipital neuralgia. This type of pain comes from the back of the head, and can radiate to the face as well.
Atypical facial pain, unlike all the others listed above, is usually idiopathic (of unknown cause) and occurs on one side of the face. Symptoms are present for most of the day, every day. The diagnosis of atypical facial pain is generally made by exclusion.
Treatment
Migraine pain is usually treated by utilizing one or more migraine medications that will either prevent or abort the pain immediately.
Dental pain is usually treated by removing or treating the offending agent. However, there are some injections that sometimes assist in treating this pain as well. TMJ pain can be treated by steroid injections directly into the joint, splints, chiropractic treatments, and anti-inflammatory medications such as ibuprophen.
Neuropathic facial pain can be treated by trigeminal nerve blocks of the trigeminal, occipital, and sphenopalatine nerves. Additionally, anti-inflammatories, anticonvulsants (gabapentin, carbamazepine), antidepressants (Cymbalta, Savella, amitriptyline), and occasionally opioids (hydrocodone), and opioid-like medications (tramadol) can all be used for neuropathic facial pain. This kind of facial pain is also commonly treated by a spinal cord stimulator or peripheral nerve stimulator. The results from a 2006 study indicate that neuromodulation (spinal cord stimulator or peripheral nerve stimulator) is extremely efficacious in the treatment of facial pain (Slavin & Coban 2006). Utilizing multiple treatments offer the most success in treating this very painful condition.
References:
- Chan-Liao, Mingi. Sphenopalatine Ganglion Block- A Simple But Underutilized Therapy for Pain Control. Retrieved February 15, 2010 from: Krolczyk, Stanley (2010)
- Persistent Idiopathic Facial Pain: Differential Diagnoses & Workup. Retrieved February 15, 2010 from: Slavin, K., Colpan, E. , Munawar, N., et al (2006).
- Trigeminal and Occipital Peripheral Nerve Stimulation for Craniofacial Pain. Retrieved February 16, 2010 from: The Mayo Clinic (2009). Trigeminal Neuralgia. Retrieved February 15, 2010