The main causes of facial pain

Facial pain is a common complaint from people, and although most of the time it will clear up on its own without the need for any medical intervention, many people still need further investigations to diagnose a cause and receive the appropriate treatment.

Dr Shankar Ramaswamy, a pain management specialist from London and Kent, gives us an overview of the various causes of facial pain, how a specialist diagnoses it and what types of treatment may be offered.

Facial pain overview

Facial pain can be felt in any part of the face and this includes your eyes and mouth. The source of the pain can either come directly from any of the various structures in your head or be referred from another part of the body. The possible sources of facial pain includes:

• nerves
• brain
• eyes
• ears
• jaw
• dental structures
• sinuses
• blood vessels
• neck
• spine
• heart

While most of the causes of facial pain are usually harmless, you and your doctor must figure out what the underlying cause is to be able to treat it accordingly.

What are the causes of facial pain?

Doctors often categories facial pain into different types depending on what the underlying cause is.

The reason you have facial pain can be from an infection, inflammation, tumour, trauma, previous surgery, dental problems, vascular cause or nerve damage.

Nerve pain

Various nerves are running in your face, allowing you to feel sensations. Neurological disorders refer to problems affecting any of these nerves which can result in facial pain. Some of these include:

• Cranial neuralgia or occipital neuralgia — this is a condition in which the nerves supplying your head or neck region become pinched, inflamed or injured. It can feel like severe piercing, throbbing or electric shocks running through your neck, head and ears. This pain may radiate down and be felt in the facial area.
• Trigeminal neuralgia — this is a chronic pain condition that affects the trigeminal nerve. It results in sudden, severe facial pain, often described as sharp, shooting pain in the jaw, teeth and gums. It normally affects just one side of the face and the unpredictable attacks last around 2 minutes.
• Post-herpetic neuralgia — this is a painful condition that affects the nerve fibres and skin. It is more commonly experienced in people who were previously affected by shingles. The pain can be burning, stabbing, electric shock sensations or throbbing.

Dental or mouth pain

There is a whole host of reasons why you may be experiencing pain in your mouth. Problems such as gum disease, cavities, damaged teeth and infections all give rise to mouth pain which can also leave areas of your face in pain too. Some other examples include:

• Burning mouth syndrome — a complex and painful condition that many people describe as a localised burning or tingling feeling in the mouth. It can appear suddenly or develop over time. It usually affects your tongue but can sometimes affect the lips, gums and throat.
• Tooth abscess — this is a build-up of pus caused when bacteria affects the soft tissue of a tooth. It can produce throbbing pain that radiates to the jaw, face and neck. Other symptoms include fever, red and painful gums and facial swelling.
• Ulcers — they can be quite painful and, if they are severe the pain and discomfort can radiate along your jaw, face and neck.

Eye and ear conditions

When facial pain is referred from either the ears or eyes it could associated with other features, such as tinnitus or vertigo in the ears or an injury to one of your eyes.

Infections can also be a reason for your facial pain. For example, conjunctivitis can result in inflammation, teary eyes and referred pain around the eye region, and similarly, an ear infection can be felt in the ear, head, jaw and across one side of your face.

Sinusitis

Your sinuses are small cavities behind your nose, forehead and cheekbones. If these become inflamed, it can create blockages that result in a buildup of mucus. Symptoms include pain and pressure in the face (more specifically around the nose), forehead and cheeks. Sinusitis usually follows a cold but can also be caused by allergies such as hay fever.

Headaches

Several headaches disorders can lead to facial pain. These may include:

• migraines
• cluster headaches
• ice pick headaches
• tension headaches

The pain, which is felt anywhere in the head can radiate towards the face. If you are experiencing recurrent headaches you should visit your doctor to get this checked out.

Spinal pain

Various conditions affect the spine that can induce headaches, which in turn, can lead to pain anywhere in the facial area. For example, a spinal headache may occur when cerebrospinal fluid (the fluid that cushions the brain) leaks out of the tissues surrounding the brain and spinal cord. Symptoms may include pain on movement of the neck, an intense, throbbing headache at the front of the head, stiffness in the neck and sensitivity to light. The pain can radiate to the back of the neck and head and cause secondary headache and facial pain. Degeneration of the cervical spine can also cause headaches and facial pain.

Jaw pain

Having pain in your jaw can spread to other areas of the face and can develop from infections, toothaches and problems with the blood vessels or nerves. Jaw pain can also result from temporomandibular joint disorder which is a group of conditions affecting the jaw joints, muscles and bones that are responsible for jaw movement. It can be common and often goes away without medical treatment. Other causes of jaw pain include:

• Trauma — such as a fracture or dislocation of the jaw bone
• Teeth clenching and grinding — this can happen while sleeping or during stress and result in muscular pain around the jaw
• Arthritis — different types of arthritis can affect your jaw joint and can wear away the bone. Pain and stiffness are common symptoms of this.
• Vascular problems — conditions affecting the vascular system can lead to jaw pain, such as temporal arteritis and angina. In temporal arteritis, the blood vessels become inflamed around the head which results in headaches and pain around the jaw area.

Injuries

Cuts, impacts and blows from falls and accidents can be associated with facial pain, especially if the injury damages any nerves in that region. Sometimes, but this is quite rare, facial surgery can lead to complications such as nerve damage. Aside from pain, the other symptoms of this can include numbness and tingling in the affected area.

How is the cause of facial pain be diagnosed?

If you are experiencing constant or recurrent facial pain that isn’t improving with time or with over the counter medications, you should visit your doctor to get it checked out. To make a diagnosis, your doctor will generally do the following as a standard practice:

1. History taking — a detailed history of the patient is taken and the should explain their symptoms, focusing on how it began, the duration, type of pain and what exactly, if anything, relieves it. A doctor will also need to know if seeing a bright light or sudden movement of the neck brings about any pain, whether it happens during a particular time of the day and if there are any associated symptoms such as dizziness, nausea or vomiting.
2. Examination — a doctor needs to check if the pain is brought about by any type of touch or stimuli. During the examination, your eye movements, spinal function and jaw movement will be checked.
3. Investigations - scans may be needed if the cause of your facial pain can't be identified from the above approaches. This may include a CT scan, MRI scan, blood tests, biopsy or special neurological tests.
4. Treatment - to offer the most effective treatment to relieve your pain, the primary problem causing the pain needs to be treated. Depending on the cause, you will be sent to the appropriate specialist, for example, if you have a dental or jaw problem, then you will be sent to see a dental specialist. Similarly, if it is a neurological condition, you will be referred to a neurologist. If the facial pain remain a long standing problem with no obvious critical medical condition, then your doctor may refer you to a pain specialist.

How can facial pain be treated?

Once a diagnosis is established, a specialist and a dedicated multidisciplinary team who deal with your particular condition will be able to offer you the most effective treatment.

Examples of the type of treatments include taking antibiotics for any infections, antiviral medications for bacterial infections like shingles, receiving an injection such as botox or an epidural, facet joint injections or nerve blocks especially if the pain becomes chronic. If your symptoms are more advanced, electrical nerve stimulation is an option for chronic neuropathic pain.

When might facial pain be an emergency?

Facial pain, particularly in the jaw, can be a symptom of cardiac problems. The pain may not feel localised but instead, it will present as more of a diffused pain that goes up to your jawline. Many people often describe this pain as having a bad toothache. Additionally, you may notice that physical activity makes it worse, such as walking upstairs.

If you are experiencing pain along your jaw as well as tightness or pressure in the chest, discomfort in your arms and shoulders and/or shortness of breath, then this is a sign of a heart attack and you should call 999 immediately.

Other conditions can mimic the symptoms of a heart attack, such as angina, gastrointestinal reflux disease, aortic dissection, broken heart syndrome and psychological disorder such as anxiety or stress. Not all of these conditions warrant an emergency response but you should always get checked out by a doctor if you are worried.

Another cause for emergency is temporal arteritis, which is an inflammation of the blood vessel in the face. This can potentially result in a stroke and blindness and you should see a doctor urgently. Patients usually present with headaches, jaw pain especially on chewing or talking, tenderness over temples or vision disturbance and generalised stiffness, as often this condition is associated with another condition called polymyalgia rheumatica. If you think you have any of these symptoms then you should urgently contact 111.

To book an appointment with Dr Shankar Ramaswamy, visit his Top Doctors profile and check his availability. If you are worried about COVID-19, he is also available for an e-Consultation where you can talk to him over a video conference from your home.