Pain in the facial muscles

It is believed that the pain in the face is either neuropathies or odontogenic (dental) diseases. Not only patients themselves, but also many doctors most often relate the pain symptom to neurological causes - neuralgia nervus facialis - facial nerve. Traditionally, facial muscle pain is referred to as prosopalgia, although as a muscular symptom, it rather refers to a separate clinical unit - myofascial pain syndrome.

Just like prosopalgia (pain in the face), myofascial syndrome is not fully understood, but it is he who causes 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: in the first stage, residual hypertonus provoked by various factors develops in the muscle tissue, then the focus of the stress is localized and becomes permanent. The most typical example is spasms (crampies) in the muscles of the jaw with active chewing or yawning. Chronic pain in facial muscles provokes secondary pathologies of the vascular system, metabolic disorders, inflammatory diseases, which supplement the overall clinical picture with its specific symptoms.

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Causes of pain in facial muscles

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

• Dysfunction of the TMJ (temporomandibular joint) or Kosten's syndrome.
• Pain symptoms, conditions caused by reflected signals from the muscles of the neck and shoulder girdle.
• MFBS - myofascial pain syndrome.
• Functional orthodontics (bruxism).
• Psychogenic factor.

A little more about each factor that causes pain in the muscles of the face: 

• In 45-50% of the muscular pain in the face is caused by Kosten's syndrome, which provokes pathobiomechanical dysfunction of the joint and manifests a pain sensation in the muscles. The specificity of the TMJ - the temporomandibular joint consists in inconsistency (incongruence) of its articular elements. Such a discrepancy normally does not cause discomfort, since it is regulated by the intraarticular disc and the lateral pterygoid muscle. If a person has problems with teeth, jaw condition, as a result, the joint is subjected to excessive load, most often asymmetric (chewing on one side). In addition, the overload of the joint can cause an incorrect bite, even at rest, when the contractile function of the chewing muscles is enhanced. This, in turn, creates pathogenic conditions for the formation of TT - trigger myofascial points in the lateral, pterygoid, medial, temporal and masticatory muscles. 
• Pain in the face as a reflection of the pain signal from the muscles of the shoulder girdle, neck. These conditions cause pain, similar to dental symptoms. If the muscular tissues of the neck and shoulders are overstrained due to a constant static load, osteochondrosis or other factors, the pain impulse is reflected in different facial zones. Most often, facial myalgia causes hypertension of the trapezius, sternocleidomastoid muscles, as well as overexertion of the suboccipital, semi-vascular, belt 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 may be banal fatigue, stressful situation, depressive state. If a person is in chronic distress, he involuntarily loses all muscles, including facial muscles - clenching his teeth. The habit of straining the oral muscles can lead to the formation of trigger pain zones in the chewing musculature. In addition, the psychoemotional factor is often the cause of nocturnal bruxism, which is analogous to daytime stress overexertion accompanied by morning pain in the facial muscles.

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Symptoms of pain in the facial muscles

The symptomatology of muscle spasm in the face is characterized by its intensity. Unlike muscle pain, localized in other parts of the body, the symptoms of pain in the facial muscles are felt by the person as intolerable, acute, strong.

The most painful manifestation of Kosten's syndrome, a violation of the TMJ. The pain in this case is asymmetric, it is one-sided, it feels like a searing pulsation. The symptom may be paroxysmal, worse at night, prone to recurrence. The pain arises spontaneously and develops wavy, spreading to different parts of the face - the gum, the lower jaw, the ear, the temple, the nose wings, the tongue, often under the eyes. Kosten's syndrome is characterized by ophthalmic manifestations - sensation of 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, articular noise. Strengthen the pain symptom can be eating, when you have to use the chewing muscle, the lower jaw. The pathology of the TMJ is accompanied by significant changes in jaw movements, restriction 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. In Kosten's syndrome, the pain is localized in the occipital part of the head, in the temples, and can extend into the shoulder girdle up to the shoulder blades. Headache can provoke and bruxism, which develops as a consequence of the TMJ.

Rarely painful sensations in the back associated with the Kosten syndrome are also rare, and the patient may experience periodic dizziness, insomnia, disorientation in space. Against the background of permanent facial pains, in 50% of cases, a depressive state develops, which only activates the pathological painful circle.

Diagnosis of pain in facial muscles

To identify the true myogenic causes of facial pains, the diagnosis of an exception should be made first of all, when an obvious clinical picture of such serious pathologies as the following is not determined: 

• Tumors of the brain.
• Ophthalmic diseases.
• Inflammation of the trigeminal nerve.
• Infectious neuritis of the facial nerve.
• Trotter's syndrome (swelling in the nasopharynx).
• Vascular pathologies (stroke).
• Sinusitis, sinusitis, frontal.
• Dental diseases.

Diagnosis of pain in the facial muscles with myofascial syndrome should reveal the classic, determining criteria: 

• Pain should be localized in a specific area.
• Pain restricts the movement of the jaw.
• At palpation in muscles the myogenic "weight" is revealed.
• Within the boundaries of the strand there must be a TT - trigger point of pain.
• Pain at palpation of TT should be reproduced abruptly, quickly - a symptom of "jump".
• The pain in the face subsides with the correct effect on the affected muscle.

The main diagnostic method in determining the myogenic character of the symptom is palpation, it is rather difficult in the diagnosis of facial muscles, although the "gold" standard is the three-finger method (three-phalanal palpation). The doctor uses the index, middle and ring fingers when probing and revealing the pain zone. Most often trigger points are localized in the masticatory muscle, less often in the temporal muscle. Other muscles, the lateral and medial pterygoids, are poorly palpated because they are difficult to "reach", so dentists are involved in the diagnosis of pain symptoms.

X-rays can be prescribed, but Kosten's syndrome does not appear in the image, it 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 complex efforts of doctors of related specializations, such as the oculist, neurologist, rheumatologist, dentist, possibly a neurosurgeon.

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Treatment of pain in facial muscles

Like any therapy, the treatment of pain in the facial muscles begins with an analysis of the diagnostic findings obtained. Typically, the myogenic symptom is stopped with non-steroidal anti-inflammatory drugs, however, in the facial muscle tissue, they may not have the desired effect.

Treatment can consist in long-term dental treatment of functional jaw disorders, for example, bite. If the pain symptom is caused by a stressful factor, the prescription of the 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 real reason will dictate the therapeutic strategy and the specificity of medications that stop pain in the facial muscles.

In general, the treatment of facial myalgia depends on the individual characteristics of the patient, as well as on the possible concomitant diseases. Usually, facial pains in the muscles are well removed by myelorelaxants and restriction of the load on the jaw, chewing muscle and TMJ (temporomandibular joint). They can be affected by injection blockades at trigger points, dry puncture, although they are very rarely used in the face area. More effective massage, acupuncture, compresses with dimexidom and simple soothing drugs - valerian, motherwort extract.

How to prevent pain in the facial muscles?

It is believed that the prevention of prosopalgia as a whole is, first of all, constant care for teeth, jaw, regular visits to the dentist. Indeed, timely correction of the bite can save a person from many unpleasant sensations, pains in the face. However, the prevention of pain in the facial muscles is slightly more specific and includes such recommendations: 

• Due to the fact that most of the 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 temporo-maxillary joint is not an independent unit, separate from the bone system. If pathological dysfunction develops in it, therefore, there are other articular diseases, including arthrosis. It is also important to monitor the condition of the prosthesis, if the prosthesis was performed incorrectly, there may be manifestations of bruxism, spasms of the chewing muscles, and pain develops accordingly.
• In the list of causes of muscle pain of the face there are also psychogenic factors. Accordingly, anti-stress methods, relaxing methods, the ability to relax in time and adequately respond to the stimulus help prevent pain in the facial muscles.
• Prevention of pain in the facial muscles can be carried out according to one of the most effective methods, which was developed by the outstanding stomatologist-orthopedist IS Rubinov. The basic principles of gymnastics are aimed at correct stretching of facial muscles, muscles of the mouth and correction of an incorrect bite. In addition to the positive result and the prevention of muscle spasms, such gymnastics will enable the fair sex to forget about age-old facial wrinkles for a long time, which is an additional positive bonus.

Pain in the facial muscles is a very complex syndrome, which has many causes and is difficult to treat. Avoid pain can be through preventive measures, oral care, regular dental examinations. In case of manifestations of pain, a timely appeal to the doctor will help, any self-medication related to the person is not just unacceptable, but also dangerous. At the first diagnostic stage, it is enough to consult a therapist, who will determine the further specifics of the examination and connect the doctors of narrow specializations to him.