Severe facial pain is most often manifested in trigeminal neuralgia (it is also called trigeminia). This is a fairly common disease that affects the more female population of the planet, especially the elderly. Most often, neuralgia has right lateralization. Vascular, endocrine diseases, as well as allergies and psychogenic factors can affect the development of this pathology. Such an ailment is considered an idiopathic disease. Trigeminal neuralgia occurs mainly due to compression of the trigeminal nerve. This can happen at two levels: intra- and extracranial, so it can be of central and peripheral origin.
In medicine, this condition is divided into primary and secondary, that is, symptomatic. The second is manifested in pathologies of the central nervous system. For example: stem stroke; multiple sclerosis; neoplasms of the cerebellar region.
Primary neuralgia occurs when the root of the trigeminal nerve is clamped at the site of its entry into the brain stem. This happens with a convoluted loop of the superior cerebellar artery (diagnosed during surgery). However, in this case, they speak of secondary neuralgia. But if the patient has not undergone any neurosurgical interventions, but there are suggestions of nerve compression, then the diagnosis is primary neuralgia (the second is diagnosed to those who underwent surgery).
Intracranial causes are the formation of tumors in the posterior cranial fossa. It is also affected by basilar artery aneurysm, meningitis, adhesions after infectious pathologies and injuries.
Extracranial causes are the formation of tunnel syndrome and local inflammatory processes. Severe facial pain can occur after tooth extraction, when a hole is damaged in the alveolar nerve - called odontogenic neuralgia, as well as in pathologies of blood flow in the brain stem and in case of a herpetic infection. In rare cases, this condition is a symptom of multiple sclerosis. As provoking factors are called: flu; syphilis; malaria hypothermia; poisoning; metabolic disorder.
Other causes of pain
The most rare neuralgia of certain areas of the trigeminal nerve, but their pain level is much stronger - this is Charlene, Frey syndrome and lingual nerve. In addition, this includes the defeat of the intermediate and facial nerve, vagus and glossopharyngeal. They appear with characteristic symptoms and require urgent treatment (it is better to carry it out in the early stages of the development of the disease).
Severe pain is also characteristic of postherpetic neuralgia, but intolerable pain can occur even during a depressive state (the latter case is called atypical facial pain).
Horton's pain in the head is noted by strong drilling pain behind the eye, which gives to the face.
Eye diseases, tooth pathologies and paranasal sinuses pass in parallel with constant throbbing pain, which tends to increase. With cancerous tumors sprouting the base of the skull, strong and regular pain in the face also appears.
An incorrect bite leads to the appearance of a temporomandibular joint syndrome, the pain of which is given to the cheek and temple. They often appear in front of the ear and become stronger during chewing food.
During the examination, you can find the pathological location of the joints and restriction of movement of the jaw. In this case, ultrasound treatment and thermal procedures are used, and occlusion correction and special exercises are prescribed to help reduce pain.
Classification of similar conditions:
- neuralgia - damage to the trigeminal nerve;
- temporomandibular joint syndrome;
- odontogenic pain;
- atypical facial pain.
How is the fit?
A classic attack of neuralgia usually goes like this: there is a strong shooting pain, which the patient compares with a current discharge; the duration of the pain is two minutes; the duration of the interval between attacks directly depends on the stage of the disease that affected it; the area of localization of pain does not change for several years; pain always has the same direction (it appears in one area and goes to another); there are areas on the patient’s face, upon irritation of which characteristic pains appear; the presence of certain factors that affect the appearance of pain; the patient’s special behavior during the attack (he does not cry and does not move, but, on the contrary, freezes in the position in which the pain caught him - some begin to immediately rub the affected area); at the peak of pain, the muscles of the face can begin to twitch.
Symptoms of the phenomenon
A different type of disease manifests itself with its characteristic symptoms, namely:
- Trigeminal neuralgia: manifests itself in the form of short, but strong, unilateral shooting pains. An attack can begin with chewing, during a grimace, after a sharp shaking of the head, during a conversation, shaving, a light touch on the face, and brushing your teeth.
- Temporomandibular joint syndrome: pain is localized in front of the ear, while it is given to the temple and cheek.
- Odontogenic infection: occurs more often at night, characterized by throbbing pain that engulfs the root of the tooth.
- Carotidinia: pain lasts several hours, while they cover not only the face, but also the neck, lower jaw, ears and teeth. Pain may occur during palpation of the carotid artery.
- Atypical reaction: these are constant pains that can be one-sided and two-sided. It can appear only on one part of the face, cover the neck. Strengthens during a stressful situation or in a warm room. It is impossible to stop it with painkillers. It is necessary to conduct a comprehensive treatment. In this case, decompression of the nerve in the facial canal is performed with drugs (most often prednisolone and diuretics). Vasoactive treatment, B vitamins, physiotherapeutic procedures, a course of therapeutic massage and gymnastics are also prescribed.
- Charlin's syndrome: manifested by severe pain in the eyes, which give into the back of the nose. Such an attack can last several hours or even days. In this case, the patient has severe lacrimation, photophobia, swelling. As therapeutic agents, analgesics and NSAIDs are used.
- Lingual nerve neuralgia: the diagnosis of this condition is based on the symptoms. For example, there is severe pain in the face, tongue, a part of the face may turn red, a dry cough begins - this happens after eating spicy food, with infectious pathologies and poisoning of the body. The attack lasts a few minutes. The patient's blood pressure may drop sharply and pass out. The affected part of the tongue often loses sensitivity. As the disease progresses, the feeling of pain disappears. For treatment, analgesics, anticonvulsants, and B vitamins are prescribed.
- Slader syndrome: there is a paroxysmal sharp pain near the eye and nasolabial triangle, while it can be given to the back of the head, neck, shoulder blade, shoulder, arm and hand. Symptoms of this condition are as follows: half of the face turns red, swelling of the face appears, abundant separation begins from one nostril, tears flow. The duration of the attack varies from a few minutes to one day.
- Myofasial facial syndrome: characterized by a complex of symptoms such as: cranial nerve neuralgia; movement disorders of the masticatory muscles; taste change; malfunctioning of the temporomandibular joint. Pain is not limited only to the face, while their duration and intensity are diverse. For example, a patient may experience only mild discomfort or suffer from unbearable pain. The feeling of pain can become stronger with severe fatigue, prolonged chewing and tightening of the jaws. In this case, symptoms such as: increased sweating; runny nose; vasospasm; dizziness; noise in ears; burning tongue.
If the above symptoms appear, you must consult an experienced specialist (such diseases are treated by a neurologist).
If facial pain is of bone origin, then several conditions are the causes: progressive caries, pulpitis, periodontitis. They can provoke osteomyelitis - this is a purulent inflammatory process in the bones of the skull. In this case, pain will appear in the direction where the decay itself began. At the same time, body temperature increases, swelling of the skin and general weakness appear.
It also provokes fractures and injuries of the skull bones. With pains only of the skin, we can talk about their pathologies. For example, soft tissue injury is considered an obvious cause. As a result of this, edema, subcutaneous hemorrhage also occur.
Deep acne is the cause of facial skin pain. Only an experienced doctor should treat this condition.
The most common cause is an allergy. It is much harder to diagnose neurological symptoms, since pain in this situation will appear from the side where the nerve is affected (the right or left side of the face will hurt).
As a treatment, medications, physiotherapeutic procedures, a change in a habitual lifestyle are prescribed. Some patients suffer from atypical face pain - this means that there are no reasons for this condition, and even with a thorough examination they cannot be established.
Psychogenic pain appears during depression, hysteria, neurasthenia, and other similar conditions. It is this type of pain that is most often diagnosed by a neurologist.
In this case, pains are distinguished: hallucinogenic - occur with mental illness (schizophrenia, manic-depressive psychosis). In this case, it is difficult to understand what exactly happens to the patient, because he describes completely insane symptoms.
Hysterical pains usually appear symmetrically, more often headaches begin in parallel with them (their intensity can vary throughout the day). The patient calls these pains “terrible and intolerant,” but they practically do not affect everyday life.
Pain in the face during depressive states is usually bilateral. In parallel, the symptoms of depression also appear: inhibition of movements; lowered corners of the mouth and more.