Headache and facial pain

Facial pain and trigeminal neuralgia

Pain in the face can arise from nerves, teeth, jaw, skin, eye or other structures. The pattern determines which route makes sense.

Facial pain is not a single diagnosis. Trigeminal neuralgia is one recognisable form, but pain in the cheek, jaw or forehead is not always nerve pain.

Start with the pattern

Facial pain can follow different routes

Location matters, but duration, quality, altered sensation, triggers and accompanying symptoms are more useful for distinguishing possible causes.

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Brief electric shocks

May fit trigeminal neuralgia when attacks are one-sided, very short and triggered by harmless stimuli.

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Teeth or jaw

Dental problems and jaw-joint or chewing-muscle symptoms may radiate to the ear, temple or face.

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Burning or numbness

May fit painful trigeminal neuropathy, for example after shingles, injury or a procedure, but requires assessment.

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Persistent diffuse pain

Persistent idiopathic facial pain is a separate classification after other explanations have been assessed carefully.

A specific nerve pain

What is trigeminal neuralgia?

The trigeminal nerve carries sensation from the forehead, mid-face and lower jaw. Trigeminal neuralgia causes recurring, very brief attacks in one or more of these areas.

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Seconds to minutes

An individual attack usually lasts from a fraction of a second to about two minutes and may recur in rapid succession.

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Harmless trigger

Touch, talking, chewing, brushing teeth, shaving or cold air may trigger an attack. People may start avoiding food or personal care.

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Usually one side

Pain stays within one or more trigeminal branches and often feels electric shock-like, shooting, stabbing or sharp.

Continuous pain can also occur

Trigeminal neuralgia may include continuous pain between attacks. This changes the assessment but does not automatically exclude the diagnosis.

Not everything is trigeminal neuralgia

What can resemble it?

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 →

Jaw, teeth and mouth

Pain with chewing, local tenderness, swelling, fever, a damaged tooth or jaw-joint symptoms needs dental or medical assessment. Avoid repeated trial treatment without a clear diagnosis.

Painful 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.

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Overlap also exists

International classification separates neuralgia, neuropathy and persistent facial pain because presentation and treatment differ. “Facial pain” starts the question; it is not the final answer.

Targeted investigation

How is facial pain assessed?

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Precise history

Where is the pain, how long does an attack last, what triggers it, is there numbness and have the eye, nose, mouth or skin changed?

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Examination and teeth

A doctor or dentist examines sensation, nerve function, mouth, teeth, jaw and other possible sources. Repeated irreversible dental treatment without evidence of a cause can be harmful.

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MRI and referral

Suspected trigeminal neuralgia may require specialist assessment and MRI to investigate vascular contact or another cause such as multiple sclerosis or a space-occupying lesion.

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Seek prompt help for new neurological loss or severe illness

New sensory loss, muscle weakness, double vision, blisters around the eye or ear, fever with swelling, difficulty swallowing or breathing, or a sudden extremely severe headache require urgent assessment.

Treatment follows the diagnosis

What may help?

Ordinary painkillers often do not adequately treat trigeminal neuralgia. Medication, procedures and support have different aims and risks; the best choice depends on cause, age, health and preferences.

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Medication

Carbamazepine is a common first treatment; oxcarbazepine may be an alternative. These medicines require monitoring for side effects, interactions and sometimes blood values.

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Specialist procedures

If benefit is insufficient or side effects are excessive, nerve procedures or neurosurgery may be discussed. Benefit, recurrence and risk of numbness differ by procedure.

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Different cause, different approach

Jaw pain, dental pain, post-herpetic nerve pain and persistent facial pain each need a different treatment. There is no single standard prescription for all facial pain.

Do not stop nerve medication suddenly without advice

Carbamazepine and similar medicines can cause side effects and interactions. Starting, changing and stopping should be discussed with the prescriber.

Living with unpredictable pain

Practical control without making your world smaller

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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.

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Food and teeth

Pain while chewing can cause weight loss or dehydration. Seek help promptly when eating or drinking becomes difficult.

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Keep one overview

Record dental procedures, scans, medicines, side effects and conclusions. This reduces the chance that each new clinician starts again.

The Zorgfuik question: is your pain pattern being assessed and referred to the right discipline, or are you 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.