What Is The Most Common Cause Of Facial Pain?

By Author: Dr. Pankaj N Surange
Total Articles: 10
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Some of the common causes of facial pain are:
1. Trigeminal Neuralgia
2. temporomandibular-disorders (TMJ) that cause pain and movement problems in jaw joints and muscles
3. Dental problems or dental abscess.
4. Herpes shingles on face
What are the common symptoms of #facialpain?
While experiencing any form of facial pain, there can be different sensations on face depending on what is causing it. More often than not, it may be due to nerve damage, muscle weakness, or headaches. Symptoms one may experience are:
a. Short periods of stabbing, shooting and tingling pain.
b. Pain during activities like brushing your teeth, washing your face, shaving, or putting on makeup.
c. Pain that can last a few seconds up to several minutes.
d. Recurrent attacks, followed by periods of lull.
e. Pain generally on one side of your face.
f. Frequent, worsened attacks over time.
g. Pain mostly in your cheek, jaw, teeth, gums, and lips.

What causes one-sided facial pain?
Most common causes of one-sided facial pain are Trigeminal neuralgia, Dental issues, ...
... Temporomandibular (TMJ) dysfunction.
What is atypical facial pain?
For decades, atypical facial pain (AFP) represented a group of disorders that included most of the facial pain disorders that did not fit into the category of classic trigeminal neuralgia. As understanding of the pathophysiology of the many facial pain disorders increased, a new classification for facial pain was developed that reflected this new knowledge. Thus, terms that were unnecessarily general were abandoned in favor of terminology that was more specific. Currently, AFP is reserved for facial pain of psychogenic origin.

Does facial nerve pain go away?
Yes, most of the facial pain can be treated and pain can be controlled. It’s important to diagnose the condition by a Pain specialist and treat it accordingly.

What is trigeminal neuralgia?
The trigeminal nerve is one of 12 pairs of nerves attached to the brain. It has three branches that communicate sensations from the top, middle, and lower areas of the face, as well as the oral cavity, to the brain.
Trigeminal neuralgia is a chronic pain disorder that affects the trigeminal nerve, also known as the fifth cranial nerve. It is a type of neuropathic pain, which is a pain associated with nerve lesions or injuries.
Most typical form of trigeminal neuralgia is type 1, or TN1, which causes attacks of sudden and severe facial pain. The pain can last between seconds and minutes. Attacks can occur one after another in cycles lasting as long as 2 hours.
Type 2, or TN2, is the atypical form of the disorder and is characterized by a constant pain that people have described as aching, stabbing, and burning at a lower intensity than TN1. A person may experience both types of pain, sometimes at the same time, which can be incapacitating.
Living with trigeminal neuralgia can be very difficult. It can have a significant impact on a person's quality of life, resulting in problems such as weight loss, isolation and depression.

What causes neuralgia to flare up?
Pain attacks in trigeminal neuralgia can be triggered by:
• eating
• drinking
• brushing teeth
• talking
• wind blowing across the face
• touching the face, such as when shaving

What can be mistaken for trigeminal neuralgia?
Trigeminal neuralgia can be mistaken for Dental issues, patients usually get dental treatments with no relief. It can also be mistaken for TMJ disorder.
Can Multiple sclerosis (MS) cause facial pain?
Yes, MS causes damage to myelin, the protective coating around nerve cells. Trigeminal neuralgia may be caused by myelin deterioration or the formation of lesions around the trigeminal nerve and cause facial neuropathic pain.
What is the treatment of Trigeminal neuralgia?
Treatment depends on the cause of Trigeminal neuralgia, age of the patient and associated co-morbidities.
Early and mild cases of Trigeminal neuralgia can be treated with Medications and are infact the first line of treatment.
Overtime, pain becomes resistant to medications or dosage increase, may cause medication related side-effects. The patient may need Intervention in that situation. This non-surgical intervention is called as Radiofrequency ablation or Radiofrequency neuromodulation of Trigeminal nerve.
Even minimally invasive surgery carries risks and should be considered a last resort. Here surgical decompression is done to relieve pressure off the Trigeminal nerve.

For how long should I wait for medicines to act for trigeminal neuralgia?
Time needed for medication to act depends upon the chronicity and severity of the Trigeminal neuralgia. The duration can range from 1 to 4 weeks.
What are the side effects of Medication?
Commonly experienced side effects include dizziness, drowsiness, forgetfulness, unsteadiness, and nausea. In addition, carbamazepine and other drugs prescribed for TN do not always remain effective over time, requiring higher and higher doses or a greater number of medications taken concurrently, and some patients experience side effects serious enough to warrant discontinuation.
What is the safer technique for trigeminal neuralgia?
A safe non-surgical treatment option for Trigeminal neuralgia is Radiofrequency ablation or Radiofrequency neuromodulation of Trigeminal nerve.
This involves a pain specialist using heat to destroy part of the nerve that causes pain. With the help of X-ray, a small hollow needle is passed through the cheek into the nerve and uses a heating current passed through electrodes to destroy nerve fibers. This procedure may not require complete anaesthesia and can be done as a day care procedure.
What are the potential complications of Radiofrequency ablation or Radiofrequency neuromodulation of Trigeminal nerve?
While radiofrequency ablation is less invasive, less risky, and requires less time in the hospital than surgery. It carries a risk of minor to severe post-surgical numbness, which can be temporary. If proper care is not taken during preparation of procedure it carries the rare general surgical risks of infection and excessive bleeding, as well as excessive nerve injury, corneal numbness, anesthesia dolorosa, and intracranial hemorrhage.
After how many days I will see the benefit of Radiofrequency ablation or Radiofrequency neuromodulation of Trigeminal nerve?
Immediately after the procedure, pain may increase for one to two days. You pain specialist will prescribe some medications to control this pain. The effect of Radiofrequency usually starts after 2 weeks and it may take 4-6 weeks for its complete effect.
Once the pain starts reducing, your pain specialist will start reducing your medications.

Dr (Maj) Pankaj N Surange MD, FIPP, FIAPM
Director, IPSC India
Hon Secretary, Indian Society for the study of Pain, National