Pain in the facial muscles

It is believed that pain in the facial area is either neuropathy or odontogenic (dental) diseases. Not only the patients themselves, but also many doctors most often associate the pain symptom with neurological causes - neuralgia of the nervus facialis - the facial nerve. Traditionally, pain in the facial muscles is attributed to prosopalgia, although as a muscle symptom it rather refers to a separate clinical entity - myofascial pain syndrome.

Like prosopalgia (facial pain), myofascial syndrome has not been fully studied, but it is the cause of 20-25% of pain in the face. The pathogenesis of myogenic facial syndromes is almost identical to the mechanism of myalgia development in skeletal muscles: at the first stage, residual hypertonicity provoked by various factors develops in muscle tissue, then the source of tension is localized and becomes permanent. The most typical example is spasms (cramps) in the jaw muscles during active chewing or yawning. Chronic pain in the facial muscles provokes secondary pathologies of the vascular system, metabolic disorders, inflammatory diseases, which complement the general clinical picture with their specific symptoms.

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Causes of facial muscle pain

If we exclude the most typical factors that provoke prosopalgia, such as dental diseases, cranial neuralgia, ENT diseases, eye diseases and vascular disorders, the truly myogenic causes of pain in the facial muscles are the following syndromes and conditions:

• TMJ (temporomandibular joint) dysfunction or Costen's syndrome.
• Pain symptoms, conditions caused by reflected signals from the muscles of the neck and shoulder girdle.
• MFPS – myofascial pain syndrome.
• Functional orthodontopathies (bruxism).
• Psychogenic factor.

A little more detail about each factor that causes pain in the facial muscles:

• In 45-50% of cases, facial muscle pain is caused by Costen's syndrome, which provokes pathobiomechanical dysfunction of the joint and manifests itself as pain in the muscles. The specificity of the TMJ - temporomandibular joint is the misalignment (incongruence) of its articular elements. Such a discrepancy normally does not cause discomfort, since it is regulated by the intra-articular disc and the lateral pterygoid muscle. If a person has problems with teeth, the condition of the jaw, as a result, the joint is subjected to excessive stress, most often asymmetrical (chewing on one side). In addition, joint overload can be caused by malocclusion, even at rest, when the contractile function of the masticatory muscles increases. This in turn creates pathogenic conditions for the formation of TT - trigger myofascial points in the lateral, pterygoid, medial, temporal and masticatory muscles.
• Facial pain as a reflection of a pain signal from the muscles of the shoulder girdle and neck. These conditions cause pain similar to dental symptoms. If the muscle tissues of the neck and shoulders are overstrained due to constant static load, osteochondrosis or other factors, the pain impulse is reflected in various facial zones. Most often, facial myalgia is caused by hypertonicity of the trapezius, sternocleidomastoid muscles, as well as overstrain of the suboccipital, semispinal, strap muscle tissue of the neck and head.
• A psychogenic factor can also be the cause of muscle pain in the face. The cause of psychoemotional overstrain can be banal fatigue, a stressful situation, a depressive state. If a person is in chronic distress, he involuntarily contracts all muscles, including the facial muscles - clenches his teeth. The habit of straining the oral muscles can lead to the formation of trigger pain zones in the chewing muscles. In addition, the psychoemotional factor is often the cause of night bruxism, which, similar to daytime stress overstrain, is accompanied by morning pain in the facial muscles.

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Symptoms of facial muscle pain

The symptoms of facial muscle spasm are characterized by their intensity. Unlike muscle pain localized in other parts of the body, the symptoms of pain in the facial muscles are felt by a person as unbearable, sharp, and strong.

The most painful manifestation is Costen's syndrome, a disorder of the TMJ function. The pain in this case is asymmetrical, one-sided, felt as a burning pulsation. The symptom can be paroxysmal, intensifies at night, and tends to recur. The pain occurs spontaneously and develops in waves, spreading to different parts of the face - the gums, the lower jaw, the ear, the temple, the area of the wings of the nose, the tongue, often under the eyes. Costen's syndrome is characterized by ophthalmological manifestations - a sensation of a foreign body in the eyes, less often - blurred vision. In addition, a person can hear an atypical sound - clicking, this is a sign of crepitus, joint noise. Eating, when it is necessary to use the chewing muscle, the lower jaw, can intensify the pain symptom. TMJ pathology is accompanied by significant changes in jaw movements, limitation in opening the mouth.

Also, the symptoms of pain in the facial muscles can be similar to many types of headaches, especially facial myalgia is similar to the clinical manifestations of migraine. With Costen's syndrome, the pain is localized in the occipital part of the head, in the temples, and can spread to the shoulder girdle up to the shoulder blades. Headache can also be provoked by bruxism, which develops as a consequence of TMJ.

Painful sensations in the back associated with Costen's syndrome are quite rare, and the patient may also experience periodic dizziness, insomnia, and disorientation in space. Against the background of constant facial pain, a depressive state develops in 50% of cases, which only activates the pathological pain circle.

Diagnosis of facial muscle pain

To identify the true myogenic causes of facial pain, first of all, it is necessary to conduct a diagnosis of exclusion, when no clear clinical picture of such serious pathologies as the following is determined:

• Brain tumors.
• Ophthalmological diseases.
• Inflammation of the trigeminal nerve.
• Infectious neuritis of the facial nerve.
• Trotter's syndrome (tumor in the nasopharynx).
• Vascular pathologies (stroke).
• Sinusitis, sinusitis, frontal sinusitis.
• Dental diseases.

Diagnosis of facial muscle pain in myofascial syndrome should identify the classic defining criteria:

• The pain must be localized in a specific area.
• The pain limits jaw movement.
• When palpated, a myogenic “cord” is detected in the muscles.
• Within the boundaries of the cord there should be a TT – a trigger pain point.
• Pain during palpation of the TT should be reproduced sharply and quickly – the “jump” symptom.
• Facial pain subsides with correct action on the affected muscle.

The main diagnostic method for determining the myogenic nature of a symptom is palpation, which is quite difficult in the context of diagnosing facial muscles, although the three-finger method (three-phalangeal palpation) is considered the "gold" standard. When palpating and identifying a painful area, the doctor uses the index, middle and ring fingers. Most often, trigger points are localized in the masseter muscle, less often in the temporal muscle. Other muscles - the lateral and medial pterygoid are poorly palpated due to the fact that they are difficult to "reach", so dentists are involved in diagnosing pain symptoms in the face.

An x-ray may be ordered, but Costen's syndrome will not show up on the x-ray in any way and is not accompanied by visible changes in the temporomandibular joint.

In general, it can be said that the diagnosis of pain in the facial muscles is quite difficult and requires the comprehensive efforts of doctors of related specialties, such as an ophthalmologist, neurologist, rheumatologist, dentist, and possibly the participation of a neurosurgeon.

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Treatment of facial muscle pain

Like any therapy, treatment of facial muscle pain begins with an analysis of the diagnostic results obtained. Myogenic symptoms are usually relieved with nonsteroidal anti-inflammatory drugs, however, in facial muscle tissue they may not have the desired effect.

Treatment may involve long-term dental treatment of functional jaw disorders, such as malocclusion. If the pain symptom is caused by a stress factor, the prescription of drugs will be associated with the restoration of the normal state of the nervous and mental sphere. Pain caused by osteochondrosis of the cervical spine will be treated according to vertebrogenic standard algorithms.

Thus, the true cause will dictate the therapeutic strategy and the specificity of drugs that relieve pain in the facial muscles.

In general, treatment of facial myalgia depends on the individual characteristics of the patient, as well as on possible concomitant diseases. Usually, facial muscle pain is well relieved by muscle relaxants and limiting the load on the jaw, chewing muscle and TMJ (temporomandibular joint). Injection blockades on trigger points, dry puncture can have an effect, although they are very rarely used in the facial area. More effective are massage, acupuncture, compresses with dimexide and simple sedatives - valerian, motherwort extract.

How to prevent facial muscle pain?

It is believed that prosopalgia prevention in general is, first of all, constant care of teeth, jaw, regular visits to the dentist. Indeed, timely correction of the bite can relieve a person from many unpleasant sensations, pain in the face. However, prevention of pain in the facial muscles is a little more specific and includes the following recommendations:

• Since most causes of pain are associated with TMJ pathology, attention should be paid to the condition of the joints in the body as a whole. The temporomandibular joint is not an independent unit, separate from the skeletal system. If pathological dysfunction develops in it, then there are other joint diseases, including arthrosis. It is also important to monitor the condition of the prostheses, if the prosthetics were carried out incorrectly, bruxism, spasms of the masticatory muscles are possible, and pain develops accordingly.
• The list of causes of facial muscle pain also includes psychogenic factors. Accordingly, anti-stress methods, relaxation techniques, the ability to relax in time and adequately respond to the irritant help prevent pain in the facial muscles.
• Prevention of pain in the facial muscles can be carried out using one of the most effective methods, which was developed by the outstanding dentist-orthopedist I.S. Rubinov. The basic principles of gymnastics are aimed at correct stretching of the facial muscles, mouth muscles and correction of malocclusion. In addition to a positive result and prevention of muscle spasms, such gymnastics will allow the fair sex to forget about age-related expression wrinkles for a long time, which is an additional positive bonus.

Facial muscle pain is a very complex syndrome that has many causes and is difficult to treat. You can avoid pain with the help of preventive measures, oral care, and regular dental checkups. In case of pain, a timely visit to a doctor will help; any self-medication concerning the face is not only unacceptable, but also dangerous. At the first diagnostic stage, a consultation with a therapist is sufficient, who will determine the further specifics of the examination and involve doctors of narrow specializations in it.