Wrinkles on the face when smiling

Facial pain: causes, symptoms, and therapy

A painful face can become a massive burden

Facial pain can affect the entire face as well as only certain regions such as the cheek, forehead, jaw or the area around the mouth. Sometimes they occur acutely and of limited duration, in other cases those affected suffer from permanent or recurring complaints. Accordingly, these can become a massive physical and psychological burden and significantly reduce the patient's quality of life. One of the most important causes of pain in the face is "trigeminal neuralgia", which is characterized by suddenly shooting, one-sided and extremely intense pain.

There are a number of possible triggers

A number of triggers for facial pain can be considered, such as shingles, problems in the jaw and teeth area, diseases of the central nervous system such as multiple sclerosis or sinusitis. In addition, facial pain can develop into chronic discomfort with no apparent cause. In this case, the medical term used is "persistent idiopathic facial pain", which predominantly affects middle-aged women and usually persists throughout the day with constant or changing intensity.

The therapy of the complaints is always based on the cause, whereby, in addition to suitable medication, physiotherapy and behavioral therapy procedures as well as various techniques to reduce stress are often used.

Definition and symptoms

The term “facial pain” is usually used to describe pain that affects either the entire face or individual areas such as the cheeks, temples, nose, jaw, around the mouth and eyes, but also the muscles of the face or the skin. These can occur on one side or in both halves of the face, and it is also possible that they radiate into the neck, shoulders or upper back. It is therefore important to differentiate the symptoms from headaches, because some forms such as cluster headaches or paroxysmal hemicrania show similar symptoms or cross over with those of facial pain.

Complaints in the face can basically occur at any age and in very different forms and intensities. Depending on the cause, they are described as knocking, pulling, burning or stabbing, for example; other sufferers report a dull and oppressive feeling. Medically, a distinction is made between acute and chronic facial pain, depending on the severity, and another point of differentiation is whether the cause is recognizable (symptomatic pain) or not (idiopathic pain).

Unilateral pain in the face

The most important pain triggers in the face include irritation of the supplying nerves, which are medically referred to as "neuralgia". Most often it is a so-called "trigeminal neuralgia", which, however, occurs relatively seldom overall (approx. 4 per 100,000 people). In this case, there is damage to or irritation of the fifth cranial nerve (trigeminal nerve), which leads to pain attacks that are among the strongest possible pain experiences.

The trigeminal nerve ("trigeminal nerve": Latin for "triple nerve") is responsible for the motor function of the masticatory muscles as well as for the sensitivity of the face. For this purpose, after emerging from the base of the skull, it divides into three branches (eye socket, mandibular and maxillary nerve), which supply the different areas of the face. In most cases of trigeminal neuralgia, the second and / or third branch are affected, which means that the symptoms mainly appear in the upper and lower jaw, nose, cheeks and chin, and sometimes also in the forehead area.

Similar to the so-called cluster headaches, the massive symptoms occur in most cases like lightning bolts on one side of the face and are described as “burning”, “stinging” or similar to a “power surge”. Such a pain attack usually only lasts a few seconds, but can be repeated frequently and in close succession throughout the day. At the same time, there are often muscle cramps on the affected side, redness, facial swelling and increased tear flow.

Often the symptoms are triggered by certain stimuli (triggers), such as touching the face, chewing, speaking or eating, in other cases they occur without a recognizable trigger. Between the painful phases, those affected usually do not experience any complaints, but since the next attack can be unpredictable at any time and triggered by a minimal amount of movement, trigeminal neuralgia usually means a massive burden and a serious reduction in quality of life.

Accordingly, the disease can have far-reaching consequences in more severe cases, as the unbearable pain can lead, for example, to depression, anxiety or a panic attack, and in serious cases even to suicidal thoughts.

Forms of trigeminal neuralgia

A distinction is generally made between two forms of the disease: In the more common "classic" trigeminal neuralgia ("tic doloreux"), for example due to hardening of the arteries (arteriosclerosis), there is a pathological vascular-nerve contact through which the nerve is sheathed (myelin sheath ) is damaged. As a result, even the smallest stimuli are enough to trigger a spontaneous discharge of the nerve and thus severe one-sided facial discomfort, whereby the second and / or third main branch are usually affected.

The second form, which occurs extremely rarely, is known as "symptomatic trigeminal neuralgia". This is due to another disease such as multiple sclerosis (MS), a stroke, vascular malformations or inflammatory diseases (shingles, borreliosis). Possible triggers are also benign nerve tumors (neurinomas) or neoplasms of a malignant tumor (metastases), which exert pressure on the trigeminal nerve or lead to abnormal vascular-nerve contact.

In this variant of trigeminal neuralgia, the first main branch or orbital nerve, which is responsible for sensations in the forehead, eye socket and frontal sinus, is also more often affected. Here the pain usually persists between the attacks and often occurs on both sides, and there are more frequent sensory disorders in the affected nerve branch.

Other forms of neuralgia

In addition to trigeminal neuralgia, other forms of neuralgia can, in rarer cases, lead to unpleasant pain in the face. If, for example, it is a so-called glossopharyngeal neuralgia, it originates from the cranial nerve IX (glossopharyngeal nerve), which is responsible, among other things, for the sensitive supply of the pharynx, trachea, lower throat and esophagus as well as for the taste sensations in the back third of the tongue.

If this nerve is damaged, pain occurs in the area of ​​the throat, tongue and the external auditory canal, which are usually very strong and occur like attacks for a few seconds. Analogous to trigeminal neuralgia, they can shoot in spontaneously and without any recognizable cause, or they can be triggered by certain trigger factors such as cold drinks, coughing, yawning or eating.

Glossopharyngeal neuralgia may have other symptoms such as poor circulation, low blood pressure or a slow pulse or heartbeat (bradycardia), as well as a temporary cardiac arrest (asystole), which, if left untreated, leads to death within a few minutes.

Facial pain in the jaw

The cause of the complaints can be problems or disorders in the tooth and jaw area. Medically, these are summarized under the term “Cranio Mandibular Dysfunction” (CMD) (Latin for “cranium” for skull and “mandibula” for lower jaw), including the entire chewing system with the upper and lower jaw, jaw joints, teeth and masticatory muscles.

Here, for example, misaligned jaws or teeth ("wrong bite"), traumatic changes in the cervical spine or the temporomandibular joints (e.g. due to a fall or a traffic accident), different leg lengths or psychosocial factors such as stress lead to a malregulation of the temporomandibular joint and the muscles involved and bones (upper and lower jaw or skull).

The result is a wide range of complaints such as toothache and jaw pain, problems opening and closing the mouth, cracking or rubbing of the temporomandibular joint, excessive tooth wear, teeth grinding or tooth loosening.

In addition to this, symptoms can occur outside of the actual jaw area, typical are mainly chronic headaches and migraines, pain in the face, dizziness, earache and ringing in the ears (tinnitus), sleep disorders, eye flickering, back and knee pain as well as shoulder and neck tension.

Chronic facial discomfort

Often it is persistent idiopathic pain, also known as "atypical facial pain", and particularly affects women between the ages of 30 and 50. It is characteristic here that there is no recognizable cause, so the symptoms cannot be assigned to typical nerve pain or any other disease. Mental disorders, for example, are discussed as triggers, and some experts also suspect that the problems could be part of a general chronic pain disorder.

Another possible cause is disorders of the nervous system as a result of an injury or operation in the ear, nose and throat, teeth, mouth or jaw area. An invasive procedure on the teeth (e.g. extraction, root canal treatment) can also develop a limited form of facial pain ("atypical odontalgia").

Those affected usually suffer from unilateral constant pain during the day, which is described as burning, boring, pulsating and deep. At night, on the other hand, this usually decreases significantly or disappears completely, so that sleep is not impaired. Longer phases without symptoms are also possible, and in the course of the disease they can also appear on the other half of the face or on both sides. Often the area of ​​the upper jaw, eyes, nose and forehead is particularly painful, but it can also spread further, e.g. into the neck or chin.

In contrast to trigeminal neuralgia, atypical facial pain does not usually lead to sudden attacks of pain and additional sensory disturbances, and there are no specific provocation factors that can trigger a flare-up. Nevertheless, in some cases the pain becomes worse, e.g. in stressful situations or due to very cold temperatures.

Often the atypical facial pain is also linked to psychological problems, with depressive moods occurring above all. In addition, some sufferers experience other physical complaints such as back pain, neck pain or migraines.

Pain in the face with a cold

The symptoms can also occur in the course of a cold, which is often referred to as a “flu-like infection”. This is an acute infection of the upper respiratory tract, which is usually caused by pathogens such as adeno-, rhino- or coxsackieviruses and is one of the most common diseases in general. Accordingly, up to three colds and up to ten colds for preschool children are on average considered to be “normal”; only when the number is higher is usually referred to as susceptibility to infection.

In most cases, the pathogens are spread via droplet infection, where they get into the air through coughing, sneezing, etc. and are then inhaled by other people. In addition, a “smear infection” is possible, in which the pathogens can get from person to person either directly (e.g. by touching an infected person) or indirectly via contaminated food, objects or drinking water. A typical way here is, for example, sneezing, in which the viruses get on the hands and from there on all objects that are subsequently touched (door handles, banisters, telephones, etc.). If someone else touches the contaminated areas, infection can occur, because the pathogens can quickly get from the hands to the mucous membranes (e.g. by scratching the nose).

Since a successful defense against the pathogen can only be achieved through an intact immune system, the risk of infection increases accordingly through immune-weakening factors such as hypothermia, stress or other diseases. In addition, being together with many people in closed rooms (e.g. at work, in kindergarten, etc.) can promote the development of a flu-like infection, especially in the cold season.

With a cold, a dry sore throat and sore throat are typical at the beginning, in the further course symptoms such as cough, runny nose, hoarseness, headache, fever, body aches and general exhaustion occur.

It is also characterized by a feeling of tension and / or facial pain, which are described as stabbing and piercing and usually intensified by pressure or when the head is bent. These are particularly pronounced with sinusitis, which is one of the most common complications of a cold.

If the weakened immune system leads to a bacterial infection (“superinfection”), tonsillitis or otitis media develop more frequently, especially in children with a cold. The spread of the cold virus to the throat, throat, bronchi, ear canal, etc. increases the risk of further complications such as bronchitis, pneumonia or larynx infection.

Cause facial palsy

Paralysis of the facial nerve (facial nerve palsy) can be indicated by pain in the ear area and face. For this, depending on the form, various causes such as an infection with Borrelia, an acute severe otitis media with inflammation of the bone, meningitis, a stroke or tumors in the brain stem can be considered. In most cases, however, facial palsy occurs without an identifiable cause (“idiopathic facial palsy” or “Bell palsy”), with a reactivated infection with the herpes simplex virus being suspected as a possible trigger.

Facial paralysis is usually characterized by paralysis on one side of the face, which typically manifests itself as the corner of the mouth hanging down. In addition, there are other symptoms such as impaired taste, reduced tears and saliva flow, dry nasal mucous membranes and hypersensitivity to noises (hyperacusis), and the eyelids can often no longer be completely closed.

Shingles

The facial complaints can be caused by shingles (herpes zoster). This is an inflammatory viral disease that can in principle occur at any age, but mostly affects older people. The disease is triggered by the "varicella zoster virus", whereby the first infection occurs in most cases in childhood and manifests itself as severely itchy chickenpox.

After the illness has been overcome, the virus remains partially "hidden" in the nerve tracts and can therefore be reactivated in later life under certain conditions and cause unpleasant shingles. However, the exact trigger for this reactivation has not yet been clearly clarified. Above all, a weakened immune system (e.g. in cancer, AIDS) and hereditary factors, stress, emotional stress or skin irritations are suspected.

Herpes zoster is characterized by a painful, streaky and itchy rash on one side of the body, which consists of red spots and small blisters. This vesicular rash usually occurs on the chest and stomach; if the varicella zoster viruses are in the cranial nerves, shingles can also develop on the face.

However, the typical rash along the affected nerve usually only shows up a few days after the infection. Instead, the first signs are a general feeling of illness, exhaustion, severe tiredness and a slight fever; the inflammation of the nerve causes severe pain and sometimes massive burning. If the herpes zoster affects the face, it can lead to numbness, tingling, toothache, visual and hearing disorders or facial muscle failures.

Other causes of facial pain

For the complaints e.g.Chronic inflammatory diseases of the central nervous system such as multiple sclerosis may be responsible, as well as the autoimmune thyroid inflammation Hashimoto's thyroiditis or the rheumatic vascular disease temporal arteritis.

If the pain occurs in the area of ​​the jaw or in the lower jaw, a heart attack can be the cause in an emergency. This is particularly conceivable if other typical heart attack symptoms such as sudden, severe, pressing or burning chest pain occur at the same time, which can radiate not only to the jaw, but also to the upper abdomen, back, left arm or shoulder.

In addition, there are other typical signs such as dizziness, tightness in the chest, paleness of the face, cold sweat, nausea and vomiting as well as severe fear and / or panic.

Danger: If there is only the slightest suspicion of a heart attack, the emergency doctor should be alerted immediately (112 or the local emergency number) and, if necessary, first aid measures such as elevating the patient, cardiopulmonary resuscitation, removing tight clothing ( e.g. tie, shirt buttons) etc.

Therapy for facial pain

Treatment always depends on the cause, which is why a thorough medical examination and precise diagnosis are particularly important. Accordingly, the therapy includes, for example, pain relievers (analgesics), so-called anticonvulsants, which are used for neuropathic or shooting pain (e.g. carbamazepine, oxcarbazepine) or tricyclic antidepressants such as amitriptyline.

If the symptoms occur chronically, a stay in a pain clinic and the targeted reduction of stress can be very helpful. Likewise, those affected can learn through behavioral therapy procedures to reduce fears and internalize coping strategies. In more severe cases, surgical measures may be indicated, but these should only be carried out after an exact indication has been established in order to avoid health risks or an aggravation of the clinical picture.

For example, if the relatively common persistent idiopathic facial pain could be diagnosed by exclusion diagnosis, a combination of drug treatment and various relaxation techniques such as autogenic training or meditation has proven successful in many cases. In addition, special pain therapies and behavioral measures can help to learn strategies for better coping and active handling of pain. This is a central point in the treatment of atypical facial pain, because since a cure is only successful in exceptional cases, the main goal is to alleviate the symptoms.

As part of drug treatment, so-called tricyclic antidepressants such as amitriptyline are often prescribed, which are also used for tension headaches. On the one hand, these intervene in the processing of pain in the brain and at the same time alleviate psychological complaints from which a large number of those affected suffer.

Under certain circumstances, anticonvulsants such as carbamazepine or gabapentin may be helpful, but pain relievers are not considered effective. Experts such as those from the German Migraine and Headache Society also advise against surgical interventions in the case of atypical pain in the face, as these can cause further damage and cause the pain to persist.

Naturopathy for aching face

If conventional pain therapy is insufficient or if there are severe side effects from the medication, alternative healing methods, e.g. in the treatment of the massive pain of trigeminal neuralgia, can be an effective help in many cases. Here, among other things, homeopathic medicines come into consideration, whereby in the case of this chronic disease, the symptoms can often only be alleviated by a combination of several suitable medicines.

Belladonna (deadly nightshade) is often recommended, especially when the pain increases with pressure, touch, movement and outdoors, while it tends to decrease when it is calm and warm. Belladonna patients often have a red and hot head, plus a fast and strong pulse, which leads to a violent throbbing in the carotid artery. In general, people who respond well to Belladonna are internally restless, agitated and often anxious, which means that they generally find it difficult to rest and often suffer from difficulty falling asleep, restless sleep and nightmares.

If the trigeminal neuralgia occurs on the left and is characterized by regularly recurring facial complaints that get worse and worse in the first half of the day, but become lighter again in the evening, Spigelia can help. If, on the other hand, the right side of the face is affected and the neuralgia is associated with numbness, Kalmia latifolia is often used. In addition, there are a number of other homeopathic remedies that have proven themselves in facial neuralgia, but also in atypical facial pain, e.g. Magnesium phosphoricum, Cactus grandiflorus, Colocynthis or Cedron.

In the case of trigeminal neuralgia, it is essential to discuss with a homeopath or naturopathic doctor whether or which remedy is possible in individual cases, because therapy should never take place on your own, especially in the case of chronic pain. Instead, the neuralgia should always first be clarified neurologically and / or dentally and in the next step the appropriate remedy (s) should be selected by an expert.

In addition to this, acupuncture can be used sensibly in the treatment of trigeminal neuralgia. In this case, however, acupuncture needles must not be inserted into the affected side in the case of severe attack-like pain, as the symptoms increase or new attacks can be triggered. Instead, the other side of the face or distant pain-relieving points on the hands and feet are first needled; in severe cases, daily treatment is often indicated, in which the needles are left in the skin for half an hour to an hour.

If the severe pain has subsided after about six to eight sessions, the diseased half of the face is also treated, but initially with a few needles and a low level of irritation. From this point onwards, according to the German Acupuncture Society, drugs that have often been used up until then can be slowly reduced, but complete relief from pain only occurs in many patients after 10 to 20 further treatments.

If a cold or sinus infection is the trigger for the sore face, various home remedies for colds can bring relief from the symptoms. For example, the Schüssler salts Kalium chloratum (No. 4), Silicea (No. 11) and Kalium sulfuricum (No. 6) as well as various applications of the proven hydrotherapy by Pastor Sebastian Kneipp ("Kneipp cure") are suitable.

Heat usually has a very beneficial effect, and steam inhalations with sage or chamomile tea, table salt or essential oils (e.g. eucalyptus, peppermint) are also effective remedies for moistening and clearing the airways. Warmth often helps with cranio mandibular dysfunction (CMD), for example by regularly placing a warm, damp washcloth on the affected area of ​​the face or irradiating it with a red light lamp. Overall, a warm bath can be very relaxing and thereby help relieve pain.

In general, in the case of chronic pain, it is advisable to take measures that strengthen the immune system. In this context, it is important to ensure a healthy, balanced diet, adequate sleep and regular physical activity. Those affected should refrain from nicotine and excessive alcohol consumption in order to avoid worsening the symptoms.

Since facial pain is often an enormous burden and impairment of the quality of life, it is also very important that patients find suitable procedures and measures to reduce stress. There are many possibilities here to achieve relaxation and a strong, balanced “center”, such as yoga, autogenic training, meditation or the progressive muscle relaxation according to Jacobson.

If there is a chronic pain condition, such as atypical facial pain, behavior therapy is usually very useful as a supplement, through which those affected learn how to better deal with the pain and thus achieve a better quality of life again. (No)

Author and source information

This text complies with the requirements of specialist medical literature, medical guidelines and current studies and has been checked by medical professionals.

Dipl. Social Science Nina Reese
  • Manfred A. Ullrich: Treating migraines and trigeminal neuralgia successfully, Spurbuch Verlag, 2014
  • Rainer Freynhagen, Ralf Baron: Neuropathic Pain, Aesopus Verlag, 2nd edition, 2006
  • Michael Rubin: Trigeminal Neuralgia, MSD Manual, (accessed September 02, 2019), MSD
  • Michael Rubin: Facial paralysis, MSD Manual, (accessed on 02.09.2019), MSD

Important NOTE:
This article is for general guidance only and is not intended to be used for self-diagnosis or self-treatment. He can not substitute a visit at the doctor.