Facial pain

One of the most difficult problems of modern medicine is considered to be facial pain. The so-called prosopalgia can be provoked by a number of reasons. Sometimes even an experienced specialist does not immediately manage to recognize the symptoms and make the correct diagnosis.

Pathologies of the nervous system, eye problems, dental and jaw disorders, ENT diseases 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 pain in a part of the face or localization in a certain area. Damage to the entire face is rare.

The main causes of facial pain are:

• neuralgia is a painful syndrome caused by irritation of the nerves;
• muscle pain;
• lesions of the bone structures of the facial part of the skull, paranasal sinuses;
• skin diseases (neoplasms, acne, inflammatory processes, etc.);
• migraines, cluster headaches, osteochondrosis, etc.

Muscle pain is a consequence of myofascial pain syndrome, which involves facial, chewing, and part of the muscle structures. Pain manifests itself in:

• malocclusion, which entails changes in chewing function, increased muscle tension and leads to excessive pressure on the teeth and jaws;
• stressful situations (some people, in fits of anger or increased anxiety, forcefully clench their jaws);
• neuralgia or mental illnesses. Nervous disorders and depressions negatively affect the performance of facial nerves, which in turn provokes excessive muscle tone and facial pain;
• cervical osteochondrosis is a painful disease that radiates to the facial area;
• various injuries.

The bones of the facial area hurt more often with pathologies of the skull, which appear as a result of:

• osteomyelitis (purulent inflammatory disease of the facial bones);
• various mechanical injuries, traumas. The most serious is a fracture of the base of the skull, and the most common is a broken nose;
• disorders in the temporomandibular joint against the background of joint diseases of an infectious or inflammatory nature, due to increased loads, injuries, malocclusion.

Facial pain accompanies pathological skin conditions. Pain may be caused by acne, allergic reactions, bruises. A separate group of unpleasant sensations includes moles, pigments, nevi, considered benign formations. Their ability to change into cancerous tumors requires increased attention. Be sure to go to the hospital if:

• the neoplasm hurts a lot;
• changes its color and structure (lags behind, protrudes, separates, etc.);
• the contours are blurred;
• is rapidly increasing;
• a wet or bleeding surface is detected.

Neuralgia (pain in the facial nerves) occurs due to pressure from a developing tumor, expansion of a tortuous vessel, and inflammation. Pain in the nerve on the face is a rather rare disease, since the facial nerve is responsible for motor activity, not for sensations.

Trigeminal neuralgia, which provides facial sensitivity, most often affects half of the face. Painful conditions of the trigeminal nerve can be caused by touching, rubbing parts of clothing, contact with a razor, etc. The area between the upper lip and nose is most susceptible to nervous tics.

Other neuralgias that cause facial pain:

• glossopharyngeal nerve - an attack is usually provoked by the intake of cold or hot food, affecting the root of the tongue, throat, tonsils and face. Increased heart rate and even loss of consciousness are possible;
• superior laryngeal nerve - an attack of pain is localized in the left or right side of the face, occurs with coughing, hiccups, increased salivation. The pain affects the neck, ear and shoulder area;
• pterygopalatine ganglion - located inside the cranium. A rare disease manifested by a runny nose, facial swelling, lacrimation, and red eyes. Facial pain affects the ear and jaw areas, eye area, and teeth;
• Nasociliary ganglion is a rare disease that causes local pain in the eyes and base of the nose. A persistent runny nose occurs against the background of reddening of the eyes and narrowing of the eye slit.

Migraines can also cause pain in one part of the face. As doctors note, women in the 20-30 age range are prone to severe headaches. Attacks of cluster pain always occur abruptly and spasmodically, affecting the eye socket area. The disease is common among the male population who abuse alcohol and smoke.

No less common causes of facial pain are:

• sinusitis - inflammation of the sinuses due to a 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 to the vessels of the eyes can lead to blindness. Pathologies of the carotid artery (carotidynia) in addition to facial pain provoke unpleasant sensations in the neck, ears, teeth, jaw;
• eye diseases – overwork, increased visual stress, conjunctivitis, tumors, diseases of nerve endings, hormonal disorders.

Causes of facial pain

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What is facial pain?

Facial pain occurs as a result of trigeminal neuralgia, inflammation of the sinuses, injuries or degenerative changes in the cervical vertebrae, brain tumors and other painful conditions.

Facial pain (prosopalgia) and headache (cephalgia) include several common syndromes (cluster headache, SANCTU syndrome, idiopathic stabbing pain), since the latter can be attributed to both the facial and non-facial areas 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 interests of differential diagnosis.

Facial pain is a complex problem in the practice of a neurologist. For successful diagnosis and treatment of facial pain, the characteristics of clinical manifestations and a clear understanding of the pathophysiological mechanisms necessary to determine a particular therapeutic tactic are of great importance. Modern approaches to the classification of facial pain, reflected, in particular, in the latest version of the classification of the International Headache Society (IHS), are also very relevant and practically significant for a neurologist. At the same time, in a number of cases, in the descriptive characteristics of certain forms of facial pain, it is appropriate to use their definitions from the classification of the International Association for the Study of Pain, which are either absent or presented too briefly in the IHS classification. Considering that in many cases pain directly in the facial area is accompanied by pain manifestations in other parts of the head, the use of the term "prosocranialgia" is entirely justified.

Symptoms of facial pain

As medical practice shows, pain most often affects one half of the face. It is not always possible to immediately recognize the problem based on the patient's condition and complaints. The symptoms of pain are so extensive and multifaceted that they can baffle even an experienced specialist. However, based on a number of painful manifestations, it is possible to immediately diagnose the disease, but some cases require careful study and additional examination.

Common symptoms of facial pain include:

• increased muscle tension;
• swelling on the face;
• increase in temperature to 38 ^o C;
• bruises;
• discharge from the ears;
• itching, redness of the skin;
• watery or dry eyes;
• persistent runny nose;
• enlargement or narrowing of the palpebral fissure;
• nervous tic;
• facial asymmetry when expressing emotions;
• taste disturbances.

Allergic reactions also cause difficulty breathing.

Pain in the facial nerve sometimes occurs with herpes rashes, pain behind the ear. Trigeminal neuralgia is described as paroxysmal, stabbing, shooting, two-minute pains. The syndrome radiates to the neck, ear, teeth, index finger.

Migraines are characterized by severe, "drilling" pains lasting up to 36 hours. Before an attack, the patient senses smells in a special way and experiences strange feelings.

Redness of the face, headache accompany hypertension. The key symptom in diagnosis can be the state of "heat" of the face. The painful syndrome can occur with nausea, unsteadiness of gait, heart pain, temporal pulsation, rapid fatigue with black spots before the eyes.

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

• stroke;
• trigeminal neuralgia;
• hypertensive crisis;
• vegetative-vascular dystonia;
• migraines;
• cervical osteochondrosis (when a nerve root is pinched);
• mental disorders, neuroses.

Atypical facial pain

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

Facial pain is expressed by a number of features:

• The risk group includes representatives of the fair sex in the range of 30-60 years;
• the pain syndrome may affect only part of the face or the entire face (in this case the pain is not symmetrical). Most patients cannot accurately describe the manifestation of pain;
• increased pain is observed at night, during stress or overheating;
• the pain covers the surface of the skin and is manifested by burning, pulsating, drilling or aching sensation;
• facial pain may radiate to the oral cavity (tongue, teeth);
• atypical pains are not constant, disappear for weeks, months and return with renewed vigor;
• accompanied by neck and headaches.

Such painful sensations arise when there is a disruption in the production of neurotransmitters in the brain that accompany the transmission of nerve impulses. The causes of pathological changes are stress, neurological and mental illnesses, regular irritating effects on the facial and cerebral nerves (for example, during dental treatment).

Psychogenic facial pain is similar in symptoms to atypical pain. It is associated with prolonged depression, hysteria, neurasthenia and various phobias. Diagnosis and treatment of this disease is a joint work of a neurologist, psychiatrist and psychotherapist.

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Diagnostic tests for facial pain

• Examination of the exit sites of the trigeminal nerve branches on the face;
• Identification of local and diffuse areas of pain during palpation and percussion of the tissues of the face and oral cavity;
• All facial muscles, tongue and temporomandibular joint are examined;
• Check the sensitivity of the face;
• Measure intraocular pressure;
• They perform X-rays, as well as computed tomography and magnetic resonance imaging, which allows for the reliable detection of diseases of the facial skeleton, cranial cavity, and nasopharynx.
• Sometimes a somatic examination is required.

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Treatment of facial pain

Medical care for patients with facial pain begins with the prescription of local or general painkillers. Non-steroidal anti-inflammatory drugs are prescribed initially. Neuroleptics and tranquilizers may be used if there is a need to enhance and obtain a longer therapeutic effect from analgesics. Along with analgesics, vitamins B are prescribed, as well as agents for normalizing the autonomic nervous system.

Today, the most balanced combination of neurotropic B vitamins is the injection solution "milgamma". Therapy begins with 2 mg intramuscularly in a single application. Maintenance dosage is the same amount of the drug two or three times a week. Sometimes the drug is used in tablet form.

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

• diadynamic current;
• magnetic laser therapy;
• electrophoresis with analgin and lidase in the area of the upper and lower jaw;
• ozokerite (a petroleum hydrocarbon);
• electrosleep;
• transcranial magnetic stimulation.

The main drug in the treatment of trigeminal neuralgia 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 is gradually increased by 1/2-1 tablet to the minimum effective (0.4 g per day). It is not recommended to exceed a 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 discontinued. In patients using the drug for a long time, its effectiveness gradually decreases. In addition, with prolonged use, the drug causes toxic damage to the liver, kidneys, bronchospasm, aplastic pancytopenia. Mental disorders, memory loss, ataxia, dizziness, drowsiness, and dyspeptic disorders may occur. The drug is known to have a teratogenic effect. Contraindications to the use of carbamazepine: atrioventricular block, glaucoma, prostatitis, blood diseases, and individual intolerance. When using it, it is necessary to periodically (once every 2-3 months) monitor a complete blood count and biochemical parameters of liver function. Other anticonvulsants that can be used to treat trigeminal neuralgia include morsuximide (morpholep), ethosuximide (suxilep), diphenin (phenytoin), and valproic acid preparations (depakine, convulex).

The possibility of surgical intervention was considered inappropriate based on a number of studies that found no relationship between facial pain and trigeminal nerve root decompression.

Treatment of atypical facial pain

Since the pathogenesis of atypical morbidity is not fully understood, and depression contributes to the aggravation of the disease, examination of patients should include psychological testing. Based on the results of behavioral characteristics, namely: anxious, depressive, hostile manifestations, a state of hypochondria (obsession with the problem of one's health) can be diagnosed. This fact requires mandatory consultation with a psychologist/psychiatrist.

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

Common selective inhibitors include "carbamezipine", the intake of which begins with half a tablet three times a day (with food). The dosage is increased daily, but it should not exceed 1.2 g per day. The drug is also widely used in the treatment of trigeminal neuralgia. Doses are reduced gradually.

Before starting to take both medications, you need to carefully study the instructions for existing contraindications and side effects. The drugs are dispensed strictly by prescription.

Facial pain, as many people think, is just a consequence of dental treatment. It happens. If the discomfort does not go away, hurry to seek help from specialists.