Brief electric shocksSeconds to about two minutes; often triggered by touch, chewing, talking or cold air.
May fit trigeminal neuralgia, especially when attacks are severe and one-sided.
Headache and facial pain
Facial pain: what can cause it and when should you seek help?
One-sided facial pain, pain around the eye or cheek, jaw pain and electric shocks can follow very different patterns. Duration, triggers and accompanying symptoms help determine the right route.
Facial pain is a symptom, not one diagnosis. It may come from nerves, teeth, jaw, skin, eyes or a headache disorder. Trigeminal neuralgia is one important cause, but not the only one.
Start with the pattern
Which facial pain pattern do you recognise?
This comparison cannot diagnose the cause. It can help you describe the pain clearly and choose a sensible first route.
Severe pain around one eyeMinutes to hours, sometimes with tearing, a red eye, blocked nose or marked restlessness.
May fit cluster headache or another trigeminal autonomic headache.
Tooth, jaw or mouth painWorse with biting or chewing, local tenderness, swelling, fever or a visibly damaged tooth.
A dentist, GP or oral and maxillofacial team may need to assess dental, jaw-joint or infectious causes.
Burning pain or numbnessContinuous burning, tingling, hypersensitivity or reduced sensation, sometimes after shingles, injury or a procedure.
May fit painful trigeminal neuropathy rather than classical neuralgia.
Persistent, poorly localised painDaily or near-daily aching that does not follow a clear nerve branch.
Persistent idiopathic facial pain is considered only after other causes have been assessed carefully.
New facial pain with warning signsNeurological loss, double vision, severe eye symptoms, fever with swelling or a sudden extreme headache.
Seek urgent medical assessment; see the warning signs below.
Location gives clues, not certainty
Facial pain on one side, around the eye, cheekbone or jaw
Facial pain on one side
Trigeminal neuralgia, cluster headache, dental disease, jaw-joint problems, shingles and migraine can all be one-sided. Left-sided and right-sided facial pain have the same broad differential; the side alone does not identify the cause.
Pain around the eye and cheekbone
Pain in the upper cheek, eye socket or cheekbone can arise from nearby teeth, the jaw, a headache disorder, the trigeminal nerve, the sinuses or the eye itself. Duration and accompanying symptoms are more useful than location alone.
Jaw, teeth and mouth
Dental pain is often localised and may worsen with biting, temperature or pressure. Jaw-joint and chewing-muscle pain can spread towards the ear and temple. Nerve pain can also feel as if it comes from a tooth, so irreversible dental treatment should have a clear dental reason.
A simple anatomical map
The three trigeminal branches in everyday language
Forehead and eye region
The ophthalmic branch carries sensation from the forehead, upper eyelid, front of the scalp and parts around the eye and nose.
Cheek and upper jaw
The maxillary branch covers much of the cheek, upper lip, side of the nose, upper jaw and upper teeth. Pain here may be described as cheekbone or upper-cheek pain.
Lower jaw and mouth
The mandibular branch carries sensation from the lower jaw, lower lip and parts of the mouth, and also supplies muscles used for chewing.
Eye and cheek pain: which details change the route?
A red or watery eye, nasal symptoms and restlessness may fit a trigeminal autonomic headache. Nausea or sensitivity to light and sound may fit migraine. Shock-like attacks triggered by touch may fit trigeminal neuralgia. Local swelling, fever, dental tenderness, a painful red eye or a change in vision require a different and sometimes urgent route.
Headache with facial pain
Migraine and cluster headache may both be felt in the face. Their attacks generally last longer than an individual trigeminal neuralgia shock and have different accompanying symptoms. Use the headache and facial-pain comparison to compare duration, location and associated signs.
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Why pain can spread through cheek, jaw, ear and eye
Neighbouring teeth, jaw muscles, joints, nerves and headache pathways can produce referred or overlapping pain. A wide painful area does not prove that every structure is diseased. Record where the pain starts, where it spreads, how long it lasts and what happens at the same time.
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“Facial nerve pain” often means something else anatomically
People commonly use this phrase for nerve pain in the face. Sensation from the face is mainly carried by the trigeminal nerve. The facial nerve mainly controls facial movement and also contributes to taste and tear or saliva production. A clinician therefore needs the pain pattern and examination rather than the search term alone.
A specific nerve pain
What is trigeminal neuralgia?
The trigeminal nerve carries sensation from the forehead, eye region, cheek, teeth, mouth and lower jaw. Trigeminal neuralgia causes recurrent, abrupt attacks in one or more of these areas. The diagnosis is clinical: a scan may help find a cause, but the pain pattern remains central.
Seconds to minutes
An individual attack typically lasts from a fraction of a second to about two minutes and may recur many times in a day.
Harmless trigger
Touch, talking, chewing, brushing teeth, shaving, washing or cold air may trigger an attack. Eating and personal care can become difficult.
Usually one side
Pain stays within one or more trigeminal branches and often feels electric shock-like, shooting, stabbing or sharp.
Classical
A blood vessel compresses the trigeminal nerve with changes to the nerve root. Vascular contact on a scan alone is not enough to explain every case.
Secondary
Another condition affects the nerve, such as multiple sclerosis or, less commonly, a space-occupying lesion. This is one reason appropriate imaging matters.
Idiopathic
No clear cause is demonstrated after appropriate assessment. That does not make the pain less real or less severe.
Continuous pain can also occur
Some people have continuous pain of moderate intensity in the same area between the shock-like attacks. International classification calls this trigeminal neuralgia with concomitant continuous pain; it does not automatically exclude the diagnosis.
Not everything is trigeminal neuralgia
Other causes of facial pain
Cluster headache and other TACs
Severe pain around one eye with tearing, nasal symptoms and restlessness follows another pattern. SUNCT and SUNA are rare, short-lasting trigeminal autonomic headaches.
Read about cluster headache →Migraine with facial pain
Migraine can be felt in the face, including the cheek or jaw, and may be accompanied by nausea and sensitivity to light, sound or movement. Attacks usually last much longer than individual trigeminal neuralgia shocks.
Read about migraine →Jaw, teeth and mouth
Pain with chewing, local tenderness, swelling, fever, a damaged tooth or jaw-joint symptoms needs dental or medical assessment. Repeated trial treatment without a demonstrated dental cause can delay the right diagnosis.
Painful trigeminal neuropathy
After shingles, trauma, surgery or dental work, a nerve may be damaged or diseased. Burning, loss of sensation or hypersensitivity fits neuropathy more than classical neuralgia.
Persistent idiopathic facial pain
This is persistent daily pain that is poorly localised and does not follow a peripheral nerve distribution. It is a recognised diagnosis, but only after dental, neurological and other causes have been assessed.
Eye, sinus, skin and infection
Inflammation, infection, shingles and eye disease can produce facial pain. Symptoms such as a rash, swelling, fever, vision change or a painful red eye change the urgency and route.
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Overlap also exists
A person can have more than one pain disorder, and continuous pain does not automatically rule out trigeminal neuralgia. “Facial pain” starts the question; duration, triggers, associated symptoms and examination refine it.
Targeted investigation
How is facial pain assessed?
There is no single test for all facial pain. The route may involve a GP, dentist, neurologist, oral and maxillofacial clinician, headache specialist, ophthalmologist or pain team, depending on the pattern.
Precise history
Where is the pain, is it always on the same side, how long does each attack last, what triggers it and are there pain-free periods? Numbness, rash, tearing, nasal symptoms, nausea and dental history all matter.
Examination and teeth
A clinician may examine facial sensation and movement, eyes, mouth, teeth, jaw and cranial nerve function. A dental examination should look for evidence of dental disease before irreversible treatment.
MRI and referral
When trigeminal neuralgia is suspected, specialist assessment and MRI are commonly used to look for secondary causes and to support treatment planning. A scan result must be interpreted alongside the clinical pattern.
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When facial pain needs urgent assessment
Seek urgent help for new facial weakness or numbness, weakness elsewhere, double vision, loss of vision, a painful red eye, blisters around the eye or ear, fever with spreading swelling, difficulty swallowing or breathing, or a sudden extremely severe headache. Call emergency services for stroke signs, severe breathing difficulty or other immediate danger.
Treatment follows the diagnosis
Treatment for trigeminal neuralgia and other facial pain
There is no universal facial-pain treatment. The aim is to match treatment to the diagnosis, measure whether it reduces attacks or restores function, and balance benefit against side effects.
First medication for trigeminal neuralgia
Carbamazepine is the standard first medicine in NICE guidance. Oxcarbazepine is widely used as an alternative in specialist practice. Doses are usually adjusted gradually according to pain relief and tolerability.
Monitoring matters
Dizziness, drowsiness, unsteadiness, nausea and interactions can limit treatment. Sodium, liver or blood abnormalities and serious skin reactions are less common but important. The prescriber decides which baseline and follow-up checks are appropriate.
If the first medicine is unsuitable
Specialists may consider other medicines, sometimes as add-on treatment, such as lamotrigine, baclofen, gabapentin or pregabalin. Evidence and suitability differ, so this is not a list to start or combine independently.
Microvascular decompression
This operation moves a compressing blood vessel away from the nerve without intentionally damaging the nerve. It can provide lasting relief for suitable people, but it is major surgery with risks that need specialist discussion.
Percutaneous procedures
Radiofrequency treatment, balloon compression and glycerol injection aim to interrupt pain transmission through the nerve. Relief may be rapid, but facial numbness and recurrence are important trade-offs.
Stereotactic radiosurgery
Focused radiation is directed at the trigeminal nerve. It avoids open surgery, but pain relief may take weeks or months and numbness or recurrence can occur.
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Ordinary painkillers and opioids
Paracetamol and anti-inflammatory painkillers usually do not control the brief electric attacks of trigeminal neuralgia. The Royal College of Surgeons guideline reports no evidence supporting opioids for trigeminal neuralgia. That does not determine treatment for every other cause of facial pain.
Review effect, side effects and safety
Agree in advance what improvement would count: fewer attacks, being able to eat or brush your teeth, or sleeping better. Keep track of adverse effects and interactions. Do not start, combine, reduce or stop nerve medication without advice; seek urgent medical advice for a severe rash, blistering, fever with rash or signs of a serious reaction.
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Different cause, different approach
Dental infection, jaw-joint pain, migraine, shingles-related neuropathy and persistent idiopathic facial pain each require a different plan. A treatment that is appropriate for one pattern may be ineffective or harmful for another.
Prepare a useful overview
What to record before an appointment
A short pain diary is often more useful than trying to remember the worst attack in the consulting room. Record enough to show the pattern, without turning the diary into a full-time task.
- Location and side: forehead, around the eye, cheek, upper jaw, lower jaw, mouth or ear; always left or right, alternating or both.
- Timing: how long one attack lasts, how often it happens and whether there is continuous pain between attacks.
- Quality: electric, stabbing, burning, throbbing, pressure-like, aching, numb or hypersensitive.
- Triggers: touch, chewing, talking, brushing teeth, shaving, wind, movement, light, food temperature or no clear trigger.
- Other symptoms: tearing, red eye, blocked nose, nausea, light sensitivity, rash, swelling, fever, weakness or altered sensation.
- Previous care: dental procedures, scans, diagnoses, medicines, doses, benefit and side effects.
Useful questions for the clinician
Which diagnosis best fits the complete pattern? Which alternatives still need excluding? Is imaging or another referral appropriate? How will we measure whether treatment works, what monitoring is needed and when should I contact you sooner?
Living with unpredictable pain
Practical control without making your world smaller
Protect a trigger zone
A scarf against cold wind, lukewarm water or adapted food may temporarily help. Discuss severe avoidance when eating, talking or personal care is at risk.
Food, drink and teeth
Pain while chewing can cause weight loss, dehydration and reduced oral care. Seek help promptly when eating, drinking or brushing becomes difficult.
Keep one overview
Record dental procedures, scans, medicines, side effects and conclusions. Ask each discipline to state what it has found and ruled out, so the next clinician does not simply restart the same route.
The Zorgfuik question: is your pain pattern being assessed and referred to the right discipline, or are you being passed between dentist, oral surgeon, GP, neurologist and pain team?
Share your experience
Where did you find the right route for facial pain?
We are looking for experiences with missed recognition, unnecessary procedures, medication, referral and collaboration.
Share your experienceCommon search questions
Frequently asked questions about facial pain
What can cause facial pain on one side?
One-sided facial pain can come from trigeminal neuralgia, migraine, cluster headache, teeth, the jaw joint, shingles, an injured or diseased trigeminal nerve, and eye or sinus problems. The side alone does not identify the cause; duration, triggers and accompanying symptoms are more informative.
What does trigeminal neuralgia feel like?
Typical attacks are sudden, severe, electric shock-like, shooting or stabbing pains on one side of the face. They commonly last from a fraction of a second to about two minutes and may be triggered by light touch, talking, chewing, brushing teeth, washing or cold air.
Can migraine cause facial pain?
Yes. Migraine pain can be felt in the cheek, jaw or around the eye, sometimes without prominent pain at the top of the head. Nausea, light or sound sensitivity and attacks lasting hours rather than seconds may point towards migraine, but assessment is needed when the pattern is new or unclear.
Is facial pain always nerve pain?
No. Facial pain may come from teeth, jaw muscles or joints, eyes, sinuses, skin, infection or a headache disorder as well as from a nerve. Burning pain, numbness or electric shocks can suggest nerve involvement, but these descriptions do not establish a diagnosis on their own.
Is facial neuralgia the same as trigeminal neuralgia?
Not necessarily. Facial neuralgia is a broad, informal term for nerve-like pain in the face. Trigeminal neuralgia is a specific clinical disorder with brief, usually one-sided, shock-like attacks in one or more trigeminal branches. Painful trigeminal neuropathy and other facial pain disorders have different patterns and may need different treatment.
What can cause pain around the eye and cheekbone?
Pain in the upper cheek, cheekbone or eye socket may come from nearby teeth, the jaw, migraine, cluster headache, the trigeminal nerve, the sinuses or the eye. A painful red eye, change in vision, fever with swelling, new neurological symptoms or a sudden extreme headache needs prompt assessment.
Which doctor treats facial pain?
The first route depends on the pattern. A GP or dentist is often a sensible starting point. A neurologist, oral and maxillofacial clinician, headache specialist, ophthalmologist or pain team may be involved when the history and examination indicate that route.
When is facial pain an emergency?
Seek urgent assessment for new facial weakness or numbness, weakness elsewhere, double vision, loss of vision, a painful red eye, blisters around the eye or ear, fever with spreading swelling, difficulty swallowing or breathing, or a sudden extremely severe headache. Call emergency services for stroke signs, severe breathing difficulty or immediate danger.
Do ordinary painkillers help trigeminal neuralgia?
Paracetamol and anti-inflammatory painkillers usually do not adequately control the brief electric attacks of trigeminal neuralgia. Carbamazepine is the standard initial medicine in NICE guidance. Treatment should be prescribed and reviewed because effectiveness, side effects, interactions and monitoring all matter.
Sources and review
Clinical classification and guidance used
Content medically checked on 1 September 2026. This page provides general information and does not diagnose an individual cause of facial pain.
- International Headache Society, ICHD-3: classification of trigeminal neuralgia, painful neuropathies and persistent idiopathic facial pain.
- NICE: trigeminal neuralgia: initial medication and specialist advice.
- NICE referral guidance: assessment and referral for atraumatic facial pain.
- Royal College of Surgeons: trigeminal neuralgia guideline: diagnosis, imaging, medication and surgical options.
- NICE: stereotactic radiosurgery: current treatment options, procedure and trade-offs.
- NHS: trigeminal neuralgia: symptoms, diagnosis and treatment.