Other Causes of Face Pain
Other Causes of Face Pain – in Order of Commonality
There are many other conditions which can cause facial pain. Some of these are:
These are by far the most common causes of oral pain. Dental pain can vary from very sharp and severe to dull and throbbing or aching. It can be difficult to locate a particular tooth. Pain is often related to eating and drinking hot, cold or sweet things. It can be made worse when eating or when there is pressure on the teeth. X-rays may be needed to locate the cause.
An inflammatory disease of the sinus that can refer pain to the upper teeth. Dull, constant tooth pain may accompany fever, nasal discharge and tiredness. Teeth and the sinus area are usually tender to the touch. X-rays can be used to detect the inflammation. Antibiotics, decongestants, antihistamines and, in severe cases, surgery are used to treat it. It tends to be short lasting but recurrent.
Myalgia or temporomandibular pain (other names Temporomandibular disorders TMD /TMJ
TMD affects twice as many women as men. The commonest cause for TMD is muscle pain in the muscles that open and close the jaw. It is usually a dull, aching constant pain in the jaw, but can be intermittent and very sharp. It can occur on both sides of the face but also on one side only. Pain is often centred in front of the ear and then spreads up the temple, down the jaw, sometimes behind the ear and into the neck. It can be felt inside the mouth, especially at the back of the mouth. Pain occurs mainly when the jaw moves. Chewing is a particularly aggravating factor. It is often associated with frequent grinding or clenching of the teeth and jaws. Sometimes there may be clicking of one or both joints, and the term used for this is disc displacement. If the disc does not move back into the resting position when the mouth is closed, then the jaw can remain open, ie, locked. Very rarely is there significant limitation in opening. Treatments include hot and cold packs, massage, muscle relaxation techniques, anti-inflammatory and muscle-relaxing medications, as well as physiotherapy. Dentists often make splints (plastic devices to cover the teeth) to prevent clenching but there is limited evidence for their effectiveness. Arthritis of the jaw is very rare and rarely causes pain – mainly only inability to open the jaw.
A dull, aching, throbbing or burning pain that is constant or nearly constant in a tooth-bearing area. Stimulating a tooth or teeth worsens the pain so it is often confused with a toothache. Teeth appear normal, however. The cause is unknown but it is sometimes treatable with antidepressants. This condition most commonly affects women in their mid-40s and is often associated with depression.
Other Conditions that have some similarity to Trigeminal Neuralgia or might initially be confused with Trigeminal Neuralgia:
A neuropathic pain which may follow an attack of shingles (herpes zoster). The pain tends to affect the eye/forehead region more so than the cheek or lower jaw regions. It is usually of a burning, aching or throbbing nature and may be accompanied by extreme tenderness. Post-herpetic pain responds well to low doses of tricyclic antidepressants and with some of the anticonvulsants used to treat classic TN.
A burning, boring, piercing or throbbing pain on one side of the head, often triggered by drinking alcohol. It is believed to be caused by dilation of the arteries inside the skull. It most often affects men aged 18 to 40. Unlike TN, cluster headache attacks may occur during sleep. Pain, in fact, is often worse when lying down. Light touch does not tend to trigger pain. Cluster headache typically occurs in a series of throbbing attacks that last 15 minutes to 3 hours at a time. Attacks may occur several times a day or every few days, and then there is a remission. Attacks also tend to “cluster” in certain time periods, especially in spring and autumn. Symptoms may also include watering of the eyes, a stuffy or runny nose, flushing on the painful side of the face and, occasionally, sweating of the forehead. A variety of medications sprays and inhalers are used to prevent and treat cluster headaches, including sumatriptan (Imitrex), ergotamine (Cafergot, Ergomar), steroids, nasal lidocaine, calcium channel blockers, and inhaled oxygen. Neurostimulators are currently being trialled for intractable cases.
Cluster tic syndrome
A blend of three types of pain: sharp stabs like TN, throbbing pain and related symptoms of cluster headaches, and a one-sided headache that follows the sharp stabs. Some say it is actually a dual case of TN and cluster headache, while others say it is a distinct condition, probably caused by damage somewhere along the trigeminal nerve’s path. TN medications, especially the ones used for atypical cases, often help, but this condition occasionally resolves itself.
This is thought to be the same as migraine but its location is more over the lower face. There are pulsating, throbbing attacks for hours or even days at a time. It typically affects nostrils, cheeks, gums and teeth and the pain may be accompanied by an upset stomach. During facial migraine attacks, patients are also often highly sensitive to noise and light. Medications such sumatriptan (Imitrex) are used to treat it.
Chronic paroxysmal hemicrania
Similar to cluster headaches, but the attacks are shorter-lasting and more frequent. It occurs mostly in females. The attacks last for 5 to 20 minutes and occur during periods of between 15 to 24 hours. It is often treated with the drug indomethacin (Indocin).
Pain at the back of the skull and up towards the ear and top of the head on one side only. It can be caused by trauma, by arthritis-related compression of the occipital nerve or by a tumour on, or pressing on, the nerve. The pain is often more prolonged and throbbing than brief and stabbing. Aching may persist between sharper attacks, but pain is usually not as severe as in other neuralgias. The condition can often be relieved with a local anaesthetic. If a tumour is found to be causing the problem, removal is an option. Otherwise, sharp pain attacks often respond to anticonvulsants such as carbamazepine (Tegretol), and more constant pain may respond to tricyclic antidepressants such as amitriptyline (Elavil), nortriptyline (Pamelor) or desipramine (Norpramin).
Post-traumatic trigeminal neuropathy
Stems from injury to a branch of the trigeminal nerve, such as the result of a fall, car accident or being hit by an object. The nerve can also be damaged during oral surgery, tooth removal, root canal filling or a dental implant. It often causes numbness instead of pain but can also be a burning pain. The condition is difficult to treat but sometimes the nerve regenerates and heals itself. Antidepressants, anti-inflammatory drugs and some anticonvulsants, such as gabapentin (Neurontin), may help. Transcutaneous electrical nerve stimulation (TENS) treatments, topical anaesthetics and analgesics such as lidocaine and hot-pepper cream are also helpful in some cases.
Chronic (persistent) idiopathic facial pain (atypical facial pain)
This is a dull, nagging ache or a sharp pain, affecting the cheeks, eyes and all non-muscular parts of the face. The pain may come and go, and tends to get worse with tiredness or stress. In addition, there may sometimes be pain inside the mouth and in other parts of the body.
Drugs, such as paracetamol, aspirin and ibuprofen do not usually relieve chronic pain. Antidepressants or anticonvulsants are often used for chronic pain relief as they modify the pain response. Antidepressants are not necessarily prescribed because the patient is depressed, although people with chronic pain can sometimes develop depression. Instead, the medication should be thought of as ‘chronic pain relief’. For example, in the same way that aspirin relieves acute pain and thins the blood, antidepressants can be used to relieve chronic pain or depression. Other things that may help include:
• Regular physical exercise
• Relaxation, eg, breathing techniques, yoga, meditation, Pilates, tai chi, mindfulness
• Taking part in enjoyable activities
• Developing distraction techniques
A chronic aching, throbbing pain around an inflamed artery in the temple area. The area is very tender to the touch, and the pain is usually one-sided and can extend down the whole jaw. Often there are prominent tortuous blood vessels in the temple area. The condition may lead to blindness if left untreated. Steroids such as prednisolone are typically used to treat temporal arteritis. Treatment is sometimes necessary for several years.
This is bouts of severe pain deep within the ear. Pain can be prolonged rather than brief and stabbing, but it often responds to the same medications as those used for TN, especially carbamazepine (Tegretol).
Very similar in symptoms to TN, only this pain affects a different cranial nerve: the one that serves the base of the tongue, throat, ear and base of the jaw. Most cases are thought to be caused by a blood vessel compressing the glossopharyngeal nerve, but in rare cases, a tumour, multiple sclerosis or a calcified ligament could be compressing or damaging the nerve. Attacks tend to occur in clusters followed by remissions. Talking, yawning and swallowing can trigger the stabs. Anticonvulsant medications often help. Microvascular decompression of the glossopharyngeal nerve is also an option.
Superior laryngeal neuralgia
This is a very rare condition that may be an offshoot of glossopharyngeal neuralgia. Pain is in the side of the throat, beneath the jaw and under the ear. Swallowing, shouting or turning the head may bring on pain. Sometimes a trigger point is present on the side of the throat. The condition sometimes goes away on its own after a few days.
In very rare cases, persistent increasing pain can be a sign of cancer or a spread of cancer from another area.
Causes of Chronic Orofacial Facial Pain - Flowchart for Diagnosis
Page last updated on 27 Jun 2015