Face Pain

Neuropathic pain – Orafacial pain

Trigeminal Neuralgia (TN)

TN is a sudden, excruciating facial pain. It’s often described as a sharp shooting pain or like having an electric shock in the jaw, teeth or gums.

The pain appears usually unilateral but in rare cases it can affect both sides of the face.

The pain is lasting from a fraction of a second to 2 minutes, it is of severe intensity and is electric shock-like, shooting, stabbing or sharp in quality.

TN is limited to the distribution of one or more divisions of the trigeminal nerve and usually triggered by stimuli such as eating, laughing, talking, brushing teeth.

It may develop without apparent cause or be a result of another disorder.

Additionally, there may or may not be continuous pain within the affected division(s).

It is of remitting and relapsing nature with varying periods of remittance.

TN is classified into

- Classical TN:Trigeminal neuralgia developing without apparent cause other than neurovascular compression.

- Secondary TN – TN caused by an underlying disease, e.g. Tumor, Multiple Sclerose, etc.

- Idiopathic TN – TN developing without a neuromuscular compression nor any other apparent underlying diseases

TN is most commonly treated with anticonvulsants such as Carbamazepine, Oxcarbazepine, Gabapentin, Lamotrigine, etc.

Surgical options are available.

Glossopharyngeal Neuralgia

A disorder characterised by severe unilateral brief stabbing, burning or electric shock type pain in the tongue, throat ear, tonsils and/or beneath the angle of the jaw.

Sudden in onset and termination, in the distributions not only of the glossopharyngeal nerve but also of the auricular and pharyngeal branches of the vagus nerve.

It is commonly triggered by swallowing, talking, coughing or yawning and may remit and relapse in the fashion of Trigeminal neuralgia.

The pain is lasting from a few seconds to 2 minutes.

Can be classified into

- Classical Glossopharyngeal Neuralgia: caused by decompression of the Glossopharyngeal nerve root

- Secondary Glossopharyngeal Neuralgia: caused by an underlying disease

- Idiopathic Glossopharyngeal Neuralgia: No neurovascular compression nor underlying disease has been found

The condition is usually responsive to anticonvulsants such as Carbamazepine, Oxcarbazepine.

Glossopharyngeal Neuropathic Pain

Pain within the distribution of the glossopharyngeal nerve (posterior part of the tongue, tonsillar fossa, pharynx or beneath the angle of the lower jaw). In addition, pain is commonly perceived in the ipsilateral ear.

The primary pain is usually continuous or near continuous, and commonly described as burning or squeezing, or likened to pins and needles.

Brief attacks of pain may occur in some cases but they are not the predominant pain type.

The combination of symptoms distinguishes Glossopharyngeal neuropathic pain from Glossopharyngeal Neuralgia.

Trigeminal Autonomic Orofacial Pain – Trigeminal Autonomic Cephalgias (TAC)

Cluster headache

Cluster headaches are excruciating attacks of pain strictly one sided facial and/or oral pain.

The pain lasts between 15 minutes and 3 hours, occurring once every day or up to eight times a day.

People often feel restless and agitated during an attack, rocking, pacing or banging their head against the wall.

The condition is characterised by one or more of the following symptoms:

- A red and watering eye

- Drooping and swelling of one eyelid

- A smaller pupil in one eye

- A sweaty face

- A blocked or runny nostril

Paroxysmal Hemifacial Pain

Attacks of severe one-sided pain around the eye, without head pain

Pain lasting from 2 to 30 minutes and occurring several or many times a day.

The attacks are accompanied by one or more of the following:

- A red and watering eye

- Drooping and swelling of one eyelid

- A smaller pupil in one eye

- A sweaty face

- A blocked or runny nostril

- Attacks can be prevented absolutely by therapeutic doses of indomethacin

Condition can be categorised by appearance into

- Episodic Paroxysmal Hemifacial Pain – Attacks of paroxysmal hemifacial pain occurring in periods lasting from 7 days to 1 year, separated by pain-free periods lasting at least 3 months and

- Chronic Paroxysmal Hemifacial Pain – Attacks of paroxysmal hemifacial pain occurring for more than 1 year without remission, or with remission periods lasting less than 3 months.

SUNFA (SUNCT/SUNHA) short-lasting unilateral neuralgiform facial pain attacks with cranial autonomic symptoms

Attacks of severe, strictly unilateral oral and/or facial pain, without head pain, lasting seconds to minutes, occurring at least once a day and usually associated with prominent tearing and redness of the eye and/or other local autonomic symp toms and/or signs.

It can be distinguished from other very similar primary headaches because of the usually very brief short lasting attacks between 1 second to 6 minutes.

The pain appears as stabbing or in a saw-tooth pattern.

The condition can be further classified into:

- Episodic SUNFA: Attacks of SUNFA occurring in periods lasting from 7 days to 1 year, separated by pain-free periods lasting at least 3 months.

- Chronic SUNFA: Attacks of SUNFA occurring for more than 1 year without remission, or with remission periods lasting less than 3 months.

Idiopathic orafacial pain

Burning Mouth Syndrome

An intraoral burning or dysaesthetic sensation, recurring daily for more than 2 hours per day for more than 3 months, without evident causative lesions on clinical examination and investigation.

The pain is usually unilateral but in rare cases can be bilateral of fluctuating intensity.

Persistent Idiopathic Facial Pain