Pain Management: Facial Pain
Pain originating in the face, or elsewhere, may be caused by an injury, an infection in a structure of the face, a nerve disorder
or it may occur for no known reason.
Some common causes of facial pain include:
- Abscessed tooth (a condition in which a tooth is surrounded by inflammation and pus)
- Sinus infection
- Sinusitis (inflammation of the sinuses)
- Injury to the face
- TMJ disorders (TMJ stands for temporomandibular joint, or the jaw joint)
- Trigeminal neuralgia (described below)
What Is Trigeminal Neuralgia?
Trigeminal neuralgia (TN), also called tic douloureux, is a condition that is characterized by intermittent, shooting pain
in the face.
Trigeminal neuralgia affects the trigeminal nerve, one of the largest nerves in the head. The trigeminal nerve sends impulses
of touch, pain, pressure, and temperature to the brain from the face, jaw, gums, forehead, and around the eyes.
What Causes Trigeminal Neuralgia?
The most frequent cause of trigeminal neuralgia is a blood vessel pressing on the nerve near the brain stem. Over time, changes
in the blood vessels of the brain can result in a blood vessels rubbing against the trigeminal nerve root. The constant rubbing with
each heartbeat wears away the insulating membrane of the nerve, resulting in nerve irritation.
What Are the Symptoms of Trigeminal Neuralgia?
Trigeminal neuralgia causes a sudden, severe, electric shock-like, or stabbing pain that lasts several seconds. The pain can be
felt on the face and around the lips, eyes, nose, scalp, and forehead. Symptoms can be brought on when a person is brushing the teeth,
putting on makeup, touching the face, swallowing, or even feeling a slight breeze.
Trigeminal neuralgia is often considered one of the most painful conditions seen in medicine. Usually, the pain is felt on one
side of the jaw or cheek, but some people experience pain at different times on both sides. The attacks of pain may be repeated one
after the other. They may come and go throughout the day and last for days, weeks, or months at a time. At times, the attacks can
disappear for months or years. The disorder is more common in women than in men and rarely affects anyone younger than 50.
How Is Trigeminal Neuralgia Diagnosed?
Magnetic Resonance Imaging (MRI) can be used to determine whether a tumor
or multiple sclerosis is irritating the trigeminal nerve. Otherwise, no test
can determine with certainty the presence of trigeminal neuralgia. Tests can, however, help rule out other causes of facial
disorders. Trigeminal neuralgia usually is diagnosed based on the patients description of the symptoms.
How Is Trigeminal Neuralgia Treated?
Trigeminal neuralgia can be treated with antiseizure medications such as Tegretol or Neurontin. The medications Klonapin
and Depakote may also be effective and may be used in combination with other drugs to achieve pain relief. Some antidepressant
drugs also have significant pain relieving effects.
If medications are ineffective or if they produce undesirable side effects, neurosurgical procedures are available to relieve
pressure on the nerve or to reduce nerve sensitivity.
Some patients report having reduced or relieved pain by means of alternative medical therapies such as
acupuncture, chiropractic adjustment, self-hypnosis or meditation.
Reviewed by the doctors at The Cleveland Clinic Neuroscience Center.
Edited by Charlotte E. Grayson, MD, WebMD, June 2004.
Portions of this page © The Cleveland Clinic 2000-2005
Last Editorial Review: 2/25/2005
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