Facial Pain
Facial pain is a particular type of pain that can occur in any part of your face. It occurs in many people and can have a variety of causes. The major types of facial pain, or conditions that can lead to it, include: neuropathic pain, trigeminal neuralgia, headaches and migraines, and atypical pain. Other conditions include dental problems or temporomandibular joint dysfunction (TMD or TMJ).
In general, there are two different nerves that are responsible for the majority of neuropathic facial pain cases: the trigeminal nerve and the sphenopalatine ganglion. The trigeminal nerve enervates many parts of your face. It has three branches, affecting three different areas of the face (e.g., lips, inside the mouth, forehead, and cheeks). One or more of these branches can lead to pain. Trigeminal neuralgia is an irritation or inflammation of the trigeminal nerve. This form of pain is very challenging, as it can be triggered by simple, everyday activities. For some people, even smiling or brushing their teeth can lead to a pain flare-up.
Another bundle of nerves responsible for some conditions is the sphenopalatine ganglion. The sphenopalatine ganglion sits directly behind your nose. It is most often connected to facial pain that occurs in the front part of your face. Neuropathic pain may also originate from the occipital nerves in a condition called occipital neuralgia. This type of pain originates from the back of the head and radiates to the face.
Atypical facial pain is usually idiopathic, meaning that there is no known cause and it generally occurs in one side of the face, and symptoms are present for most of the day, every day. The diagnosis of atypical facial pain is made after more common causes are excluded.
Identifying the correct nerve that’s causing your pain is vital to establishing a treatment plan. The most successful pain treatments typically rely on a comprehensive approach. Your doctor may include one of more of the following seven treatments in your overall pain management plan.
1. Over-the-counter medications - Non-steroidal anti-inflammatory medications can be helpful in treating pain. Use as directed by your doctor for best results.
2. Comfort measures - Hot or cold therapy can be remarkably effective in treating any kind of pain and inflammation, and facial pain is no different.
3. Prescription medications - Some medications used for neuropathic pain include anticonvulsants (gabapentin, carbamazepine) and antidepressants (Cymbalta, Savella, amitriptylline). Migraine pain is usually treated by utilizing one or more migraine medications, typically one that aims to prevent an onset of symptoms and another that reduces the duration of a migraine should one occur. Note that opioid therapy is generally no longer recommended for chronic pain conditions (including facial pain).
4. Splints - Splints are used most frequently to treat pain caused by temporomandibular joint disorder (commonly referred to as either TMD or TMJ). These position the jaw to relieve pain and ease soreness.
5. Nerve blocks - Nerve blocks can both diagnose the cause of your nerve pain and also help relieve pain in some patients. These may include: trigeminal nerve blocks, occipital nerve blocks, and sphenopalatine ganglion blocks.
6. Injections - Steroid injections directly into the joint may help with TMD pain. Trigeminal neuralgia patients may also find relief with a steroid injection that includes calcitonin. Botox injections may also help some patients with severe migraines.
7. Neuromodulation - Severe neuropathic facial pain is also commonly treated by neuromodulation, such as a spinal cord stimulator or a peripheral nerve stimulator. A 2019 review of literature found promising results for neuromodulation in the relief of intractable pain.