Other Causes of Face Pain
Besides the many dental problems that are sometimes initially confused with TN, there are many other conditions which can cause facial pain. Some of these are:
Dull, aching, throbbing or burning pain that is constant or nearly constant. 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 sometimes treatable with antidepressants. This most commonly affects women in their mid-40s and is often associated with depression.
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. This is often treated with the drug indomethacin (Indocin).
Burning, boring, piercing or tearing 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, then there is a remission. Attacks also tend to “cluster” in certain time periods, especially in spring and autumn. Symptoms may also include tearing 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. Several surgeries designed to selectively damage the nerve or parts of the brain are available if all else fails.
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.
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 items. It can be made worse when eating or when there is pressure on the teeth. X-rays made be needed to locate the cause.
Pulsating, ice-pick-like pain that also occurs in 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 as indomethacin (Indocin) and sumatriptan (Imitrex) are used to prevent and treat it.
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 trigger the stabs. Anticonvulsant medications often help. Microvascular decompression of the glossopharyngeal nerve is also an option, as are procedures that sever the nerve.
Myofascial pain or temporomandibular pain
Dull, aching constant pain in the jaw that is worst when chewing. It is an affliction of the jaw muscle rather than the nerves, often associated with frequent grinding or clenching of the teeth and jaws. A key sign of myofascial pain is that the patient has tender jaw muscles and cannot open his or her mouth wide. Hard “knots” may develop on the jaw muscle. Other symptoms often include tearing of the eyes, a stuffy nose and trigger points that activate pain when pressed, rather than lightly touched. Anti-depressant drugs may help. Local anaesthetic injections usually give temporary relief.
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. 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).
A neuropathic pain which may follow an attack of shingles (herpes zoster). The pain tends to strike 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.
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 dental implant. It often causes numbness instead of pain but can be a burning pain. This 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.
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 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.
Superior laryngeal neuralgia
This is a 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.
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. It 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.
Temporomandibular joint disorder (TMJ or TMD)
Muscle pain in the jaw believed to be caused by injury to the joint, arthritis, grinding of the teeth, muscle tension, stress or possibly teeth that do not meet properly. Pain occurs mainly when the jaw moves or is touched. Chewing is a particularly aggravating factor. TMD affects twice as many women as men. Treatments include hot and cold packs, massage, muscle relaxation techniques, anti-inflammatory and muscle-relaxing medications, dental appliances and, if all else fails, surgery.
An inflammation of the trigeminal nerve that is often described as a dull burning pain, and sometimes as a crawling feeling. Either way, the feeling is usually constant, not fleeting. Diabetics are prone to get trigeminal neuritis. It is usually treatable with anti-inflammatory drugs.
Page last updated on 30 Jan 2012