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Facial pain
Last reviewed: 06.07.2025
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Facial pain, or, in other words, prosopalgia, is one of the most difficult problems of modern medicine. Painful sensations can arise due to any pathologies of the nervous and dental systems, eye diseases and ENT organs, etc. In this regard, the patient is treated by doctors of various specializations. Facial pain is very common in medical practice.
Facial pain is a complex problem in the practice of a neurologist. For successful diagnosis and treatment of 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 classification, reflected, in particular, in the latest version of the classification of the International Society of Pain in the Face (ISPS), 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, it is appropriate to use their definitions from the classification of the International Association for the Study of These Conditions, which are either absent or presented too briefly in the ISPS classification.
[ What causes facial pain?
Facial pain can be caused by various cranial neuralgias, such as trigeminal neuralgia, dental diseases, cervical spine injuries, pathologies in the paranasal sinuses, temporal arteritis, tumors of the skull, nasopharynx, etc.
One of the rarest diseases that cause facial pain is glossopharyngeal neuralgia. The patient feels paroxysmal discomfort in the tonsils, the depth of the oral cavity, the root of the tongue, and occurs when swallowing (especially cold liquids), yawning, coughing, talking, chewing. Often, facial pain can radiate to the neck and ear. Even slight pressure on the tragus, tonsils, or soft palate is accompanied by pain. Facial pain can last for several minutes and cause fainting, a drop in blood pressure, and bradycardia.
Facial pain may be a symptom of neuralgia of the superior laryngeal nerve. It is characterized by paroxysmal unilateral or bilateral pain in the larynx and lower jaw, "radiating" to the ear, eye, shoulder girdle, and chest.
Another cause of pain syndrome in the facial area is considered to be neuralgia of the pterygopalatine ganglion. Painful sensations in this situation are concentrated in the area of the ear, eye, soft palate, teeth, jaw, and can radiate to the cervical-shoulder-scapular region. This disease is characterized by symptoms such as facial swelling, nasal congestion, lacrimation, scleral injection on the side of pain, migraine, headache and cervicogenic pain in the face.
Also, facial pain may be a consequence of neuralgia of the nasociliary ganglion, accompanied by pain in the area of the root of the nose, the inner corner of the eye, blepharospasm, conjunctival injection, nasal congestion, and nasal discharge. When instilling a cocaine-adrenaline mixture into the nose, facial pain disappears in the nasal area, but not in the eye area.
Disorders of the temporomandibular joint are fraught with the appearance of pain in the frontal, temporal, mandibular and cheek areas. Also, pain syndrome in these areas of the face can appear as a result of myofascial syndrome of the masticatory muscles, degenerative or inflammatory diseases of the temporomandibular joint, abnormal bite.
Pain in the face, teeth, lower jaw, ear, upper neck, lasting up to several hours, can be caused by carotidynia.
The most common cause of pain in the facial area is odontogenic pain. Causes of pain syndrome in the lower and upper jaw are irritation of nerves due to caries, periodontal abscesses, and pathologies of the dental pulp. Often, pain in the face is pulsating in nature, intensifies at night, and is most acutely felt in the area of the tooth root. An attack of pain can be felt while eating sweet, cold, or, conversely, hot food or liquid.
Atypical prosopalgia, which causes pain in the face, most often affects women aged 30-60. The disease is diagnosed if organic causes of pain cannot be identified. Usually, the pain syndrome is felt in half of the face and neck, but sometimes it is localized only in the face and is present constantly. Often, the pain in the face is aching, pulsating, drilling, pressing, burning in nature.
Muscle pain in the face occurs due to tension in the muscles involved in facial expressions and chewing, as well as the neck muscles. This pain is called myofascial pain syndrome of the face.
If you experience pain in your face, you should immediately consult a doctor to determine the cause of the pain.