Face Pain

One of the most difficult problem of modern medicine is facial pain. The so-called prozopalgia can be provoked by a number of reasons. Sometimes even an experienced specialist does not immediately recognize symptomatology and put a correct diagnosis.

Pathologies of the nervous system, eye problems, dentoalveolar disorders, diseases of the ENT organs and many other factors cause facial pain. For this reason, the patient is examined by doctors of several specializations.

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Causes of Facial Pain

The most common case is the soreness of a part of the face or the localization in a certain zone. The defeat of the face is rare.

The main causes of facial pain: 

• Neuralgia is a painful syndrome caused by irritation of the nerves; 
• muscle pain; 
• lesions of bone structures of the facial part of the skull, appendages of the nasal sinuses; 
• diseases of the skin (neoplasms, acne, inflammatory processes, etc.); 
• migraine headache, cluster headache, osteochondrosis, etc.

Muscle pain is the result of myofascial pain syndrome, in which mimic, chewing, and also a part of the muscular structures are involved. Soreness manifests itself when: 

• violation of the bite, which leads to changes in the masticatory function, increased muscle tension and leads to excessive pressure on the teeth, jaws; 
• stressful conditions (some in attacks of anger, increased anxiety with force close jaws); 
• neuralgia or mental illness. Nerve disorders, depressions negatively affect the performance of the nerves of the face, which in turn provokes an excessive increase in muscle tone and facial pain; 
• osteochondrosis of the cervical spine is a painful disease radiating to the face area; 
• various injuries.

The bones of the facial region ache more often with the pathologies of the skull that appear as a result: 

• osteomyelitis (a purulent-inflammatory disease of the bones of the face); 
• various mechanical injuries, injuries. The most serious is a fracture of the base of the skull, and a common fracture of the nose; 
• violations in the temporomandibular joint on the background of joint diseases of an infectious or inflammatory nature, because of increased loads, injuries, malocclusion.

Facial pain accompanies the pathological conditions of the skin. Soreness can be caused by youthful acne, allergic reactions, bruises. In a separate group of unpleasant sensations are moles, pigments, nevi, considered to be benign entities. Their ability to change into cancerous tumors, requires increased attention. Be sure to go to the hospital if: 

• neoplasm strongly hurts; 
• changes its color and structure (behind, protrudes, divides, etc.); 
• contours blur; 
• is rapidly increasing; 
• a wet or bleeding surface is found.

Neuralgia (tenderness of the facial nerves) are manifested due to the pressure of the developing tumor, enlargement of the convoluted vessel, inflammation. Nerve pain on the face is a rare disease, as the facial nerve is responsible for motor activity, and not for sensation.

Neuralgia of the trigeminal nerve, which provides sensitivity to the face, often spreads to half the face. Causing painful conditions of the trigeminal nerve can touch, rubbing parts of clothing, contact with a razor, etc. The maximum prone to nerve tics is the area between the upper lip and nose.

Other neuralgias that respond to the pain of the face: 

• the glossopharyngeal nerve - an attack, as a rule, provokes the intake of cold or hot food, affecting the root of the tongue, throat, tonsils and face. There may be an increase in the heart rate and even a loss of consciousness; 
• the upper laryngeal nerve - an attack of soreness is localized in the left or right side of the face, proceeds with coughing, hiccoughing, increased salivation. The pain grasps the neck, ear and shoulder area; 
• the pterygopalatine nerve node is located inside the skull. A rare disease is manifested by a runny nose, puffiness of the face, lacrimation, redness of the eyes. The facial pain covers the ear and maxillary zones, the eye area and teeth; 
• The nasociliary nervous nodule is no less a rare disease in which the local tenderness of the eyes and the base of the nose is expressed. An unbroken runny nose runs against the background of red eyes and narrowing of the eye gap.

Migraines can also cause pain in one part of the face. As doctors say, severe headaches affect women in the range of 20-30 years. Attacks of cluster pain always appear abruptly and spasmodically, capturing the orbit zone. The disease is common among men who abuse alcohol and smoking.

No less frequent causes of facial pain are: 

• sinusitis - inflammation of the sinuses of the nose with respiratory disease; 
• problems with the vessels on the face. For example, vasculitis (an inflammatory process in the vessel wall) manifests itself as a burning pain in the temporal zone and upper jaw. Spreading on the vessels of the eyes can lead to blindness. Pathologies of the carotid artery (carotidinia), in addition to facial pains, provoke unpleasant sensations in the neck, ears, teeth, and jaw; 
• eye diseases - overfatigue, increased visual loads, conjunctivitis, tumors, nerve endings, hormonal disorders.

Causes of Facial Pain

[2], [3], [4]

What is facial pain?

Facial pains occur as a result of neuralgia of the trigeminal nerve, inflammation of the sinuses of the nose, trauma or degenerative changes in the cervical vertebrae, brain tumors and other painful conditions.

Facial pains (prozopalgia) and headaches (cephalgia) include several common syndromes (cluster headaches, STD syndrome, idiopathic stitching pain), since the latter can be referred to both the facial and non-facial region of the head; thus, there is no generally accepted unambiguous boundary between some of these syndromes. We partially repeat them in this section in the interest of making a differential diagnosis.

Facial pain is a complex problem in the practice of a neurologist. For the successful diagnosis and treatment of facial pain, particular features of clinical manifestations and a clear idea of the pathophysiological mechanisms necessary to determine a therapeutic tactic. Very relevant and practical for the neurologist are also modern approaches to the classification of facial pain, reflected, in particular, in the latest version of the classification of the International Headache Society (MOGB). However, in a number of cases, descriptive characteristics of various forms of facial pains are relevant to the use of their definitions from the classification of the International Pain Association, which in the MOGB classification are either absent or presented too briefly. Given that in many cases pain directly in the face is accompanied by painful manifestations in other parts of the head, the use of the term "prosocranialgia" is justified.

Symptoms of facial pain

As medical practice shows, pain most often affects one half of the face. On the patient's condition and his complaints, it is not always immediately possible to recognize the problem. Symptomatic pain is so vast and multifaceted that it can confound even an experienced specialist. However, for a number of painful manifestations, it is possible to diagnose the disease instantaneously, but some cases require careful study and additional examination.

Common symptoms of facial pain: 

• increased muscle tension; 
• swelling in the face; 
• increase in temperature to 38 ^o C; 
• bruising; 
• discharge from the ears; 
• itching, redness of the skin; 
• lacrimation or dry eyes; 
• a persistent runny nose; 
• increase or narrowing of the ocular gap; 
• a nervous tic; 
• asymmetry of the face when expressing emotions; 
• disturbance of taste sensations.

In allergic manifestations, breathing difficulties are also observed.

Pain in the facial nerve sometimes occurs when the herpes rashes, soreness behind the ear. Neuralgia of the trigeminal nerve is described as paroxysmal, pricking, piercing, two-minute pain. The syndrome radiates to the neck, ear, teeth, index finger.

Migraines are characterized by strong, "drilling" pain lasting up to 36 hours. Before the attack, the patient feels a special smell, he has strange feelings.

Redness of the face, pain in the head accompany hypertension. A key symptom in the diagnosis can be the state of "heat" of the face. Painful syndrome can occur with nausea, gait unsteadiness, heart pain, temporal pulsation, rapid fatigue with black dots in front of the eyes.

Numbness, as a rule, is associated with nervous or vascular dysfunctions. The condition is noted as a result of: 

• stroke; 
• trigeminal neuralgia; 
• hypertensive crisis; 
• vegetative-vascular dystonia; 
• migraine; 
• cervical osteochondrosis (with a jamming of the nerve root); 
• mental disorders, nerves.

Atypical facial pain

Atypical facial pain is a diagnosis that is applied to a pain syndrome without an established cause as a result of careful examination of the patient. There is an opinion that such a picture arises against the background of mental disorders or from the side of nervous pathologies.

The facial pain is expressed by a number of features: 

• in the group of risk are women of the fair sex in the range of 30-60 years; 
• The pain syndrome can be affected only by a part of the face or the entire face (in this case the soreness is not symmetrical). Most patients can not accurately describe the manifestation of pain; 
• increased morbidity is observed at night, during stress or overheating; 
• pain covers the surface of the skin, is manifested by burning, pulsation, boring or aching sensation; 
• tenderness of a person can give into the mouth (tongue, teeth); 
• Atypical pains are not permanent, disappear for weeks, months and come back with renewed vigor; 
• accompanied by cervical, headaches.

Such painful sensations arise when the output of neurotransmitters in the brain, accompanying the transmission of nerve impulses, is disturbed. The causes of pathological changes lie in stresses, neurological and mental illnesses, regular irritant effects on the facial, head nerves (for example, with dental treatment).

The facial pain of a psychogenic character is symptomatic similar to an atypical one. She is credited with states of protracted depression, hysteria, neurasthenia and various phobias. Diagnosis and treatment of this ailment is a joint work of a neurologist, psychiatrist and psychotherapist.

[5], [6]

Diagnosis of facial pain

• Examination of the exit sites of branches of the trigeminal nerve on the face;
• Identification of local and diffuse zones of soreness with palpation and percussion of the tissues of the face and oral cavity;
• Examine all the facial muscles, tongue and temporomandibular joint;
• Check the state of sensitivity on the face;
• Measure the intraocular pressure;
• X-rays are taken, as well as computer and magnetic resonance tomography, which allows for the detection of facial skeleton, skull and nasopharyngeal cavities.
• Sometimes somatic examination is required.

[7], [8], [9],

Treatment of facial pain

Medical care for patients with facial pain begins with the appointment of anesthetic drugs of local or general impact. Primarily prescribed anti-inflammatory substances of the nonsteroid group. It is possible to use neuroleptics, tranquilizers, if necessary, to enhance and obtain a longer therapeutic effect on analgesics. In parallel with taking analgesics, vitamins B are prescribed, as well as means for normalizing the work of the autonomic nervous system.

To date, the most balanced combination of neurotropic vitamins of group B has a solution for injection of "milgamma". Therapy is started with 2 mg intramuscularly once-only. Maintenance dosage - the same amount of the drug two or three times a week. Sometimes a medicine is used in the form of tablets.

Medicamental treatment of facial pain should be supplemented with physiotherapy procedures: 

• diadynamic current; 
• magnetolaser therapy; 
• electrophoresis with analgin and lidase in the zone of the top and bottom of the jaw; 
• ozokerite (hydrocarbon of oil group); 
• electrosleep; 
• transcranial magnetic stimulation.

The main drug in the treatment of neuralgia of the trigeminal nerve is carbamazepine (carbasan, finlepsin, tegretol, stazepine, mazetol). Carbamazepine promotes GABA-ergic inhibition in neuronal populations prone to paroxysmal forms of activity. Treatment begins with a dose of 0.1x2 times a day. Then the daily dose gradually increases by 1 / 2-1 tab. To minimally effective (0.4 g per day). Do not exceed the dose of more than 1200 mg / day. After 6-8 weeks after the onset of the effect, the dose is gradually reduced to the minimum maintenance (0.2-0.1 g per day) or completely abolished. Patients who use the drug for a long time gradually decrease its effectiveness. In addition, with prolonged use, the drug causes toxic damage to the liver, kidneys, bronchospasm, and aplastic pancytopenia. There may be mental disorders, memory loss, ataxia, dizziness, drowsiness, dyspeptic disorders. It is known that the drug has a teratogenic effect. Contraindications to the use of carbamazepine: atrioventricular blockade, glaucoma, prostatitis, blood diseases, individual intolerance. When it is used, it is necessary periodically (once in 2-3 months) to monitor the general blood test, the biochemical parameters of liver function. Of the other anticonvulsants for the treatment of trigeminal neuralgia, there may be used morsuximide (morpholip), ethosuximide (sulex), diphenin (phenytoin), valproic acid preparations (depakin, convulux).

The possibility of surgical intervention was found to be inexpedient on the basis of a number of studies in which it was established that there is no correlation between facial pain and decompression of the spinal nerve root.

Treatment of atypical facial pain

In view of the fact that the pathogenesis of atypical tenderness is not fully understood, and depression contributes to the aggravation of the disease, the examination of patients should include psychological testing. Based on the obtained results of behavioral characteristics, namely: anxious, depressive, hostile manifestations, the condition of hypochondria (fixation on the problem of one's health) can be diagnosed. This fact requires the obligatory consultation of a psychologist / psychiatrist.

Atypical facial pain treatment of seizures is based on the principles of psychotherapy with concurrent use of antidepressants. The treatment regimen and preparations for the patient are selected individually. Among the most effective tricyclic drugs are "amitriptyline" with an average daily dosage of up to 200 mg (with or after meals). After two to four weeks, the dose is reduced.

To widespread selective inhibitors carry "carbamezin", which reception begin with half of a tablet three times a day (with meal). Daily dosage is increased, but per day it should not exceed 1.2 g. The drug is widely used also in the treatment of trigeminal neuralgia. Dose reduction is carried out gradually.

Before you start taking both drugs, you need to carefully study the instructions for existing contraindications and side effects. Drugs are released strictly on prescription.

Facial pain, as many think, is just the result of dental treatment. It also happens. If the discomfort does not go away, hurry for help to specialists.