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The Cleveland Clinic

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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Trigeminal Neuralgia

Introduction

Neuropathic pain is a complex, chronic pain state that usually is accompanied by tissue injury. With neuropathic pain, the nerve fibers themselves may be damaged, dysfunctional or injured. These damaged nerve fibers send incorrect signals to other pain centers. The impact of nerve fiber injury includes a change in nerve function both at the site of injury and areas around the injury.

One example of neuropathic pain is called phantom limb syndrome. This occurs when an arm or a leg has been removed because of illness or injury, but the brain still gets pain messages from the nerves that originally carried impulses from the missing limb. These nerves now misfire and cause pain.

What causes neuropathic pain?

Neuropathic pain often seems to have no obvious cause; but, some common causes of neuropathic pain include:

  • Alcoholism
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  • Back, leg, and hi...

Read the Neuropathic Pain article »










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