FAQ’s on Facial Pain Treatment in Philadelphia

Facial pain and headache are seen often in the primary care setting. Because these conditions are often chronic problems, pain management can help. Facial pain can occur after dental or sinus surgery, or from skull or facial trauma.

What causes facial pain?

The cause of facial pain depends on the precipitating event. Some common causes include:

  • Trigeminal neuralgia – This disorder affects the sensory divisions of the trigeminal nerve. Symptoms include electric-shock pain on one side of the face, spasms of pain, and hypersensitivity to mild touch.
  • Postherpetic neuralgia – This occurs after a herpes zoster (shingles) infection. The pain is associated with hyperalgesia (increased sensitivity). The trigeminal nerve is usually affected.
  • Temporomandibular joint (TMJ) syndrome – This condition affects the joint that controls the jaw. Characteristics of this problem include tenderness when eating, chewing gum, and speaking, pain that is dull, burning or aching, and radiating discomfort to the side of the head and/or ear.
  • Cluster headaches – These cause pain that is intense and on one side of the head. The pain often radiates to the cheek, temples, forehead, neck, or ear. This headache is associated with tearing of one eye, and nasal stuffiness on the same side of the head as the pain.
  • Facial injury – This occurs from a motor vehicle accident, sporting injury, or fall.
  • Chronic toothache – People with poor dentition have facial pain.

How common is facial pain?

Based on statistics, the prevalence rate of facial pain is around 26%. This type of pain affects women slightly more than men. People 18-25 years of age report having more facial pain than those of younger and older age groups

What is persistent idiopathic facial pain?

Persistent idiopathic facial pain (PIFP) is pain along the trigeminal nerve that does not fit the classic characteristics of other causes of pain. The duration of the pain involves severe aching, burning pain, and a crushing sensation.

How is facial pain diagnosed?

To diagnose facial pain, the doctor will ask you questions about your symptoms and conduct a physical examination. In addition, the doctor uses diagnostic tests to uncover pathology. These include computed tomography (CT) scans, x-rays, and magnetic resonance imaging (MRI) scans.

How is facial pain treated?

Treatment of the pain depends on the cause. Options include:

  • Medications – These include anticonvulsants, beta-blockers, anti-inflammatory medications, antidepressants, and serotonin agonists. Certain topical gels and patches are also used for facial pain. For severe, intractable pain, the doctor may prescribe a narcotic analgesic.
  • Sphenopalatine ganglion block (SGB) – The sphenopalatine ganglion is a mass of nerves positioned below the brain and at the back of the throat. With this procedure, the doctor inserts a small catheter through a nostril and injects an anesthetic agent onto the nerves. For long-term pain relief, a neurolytic agent is used, such as absolute alcohol or phenol. In a recent study, two-thirds of patients reported pain relief with this block.
  • Occipital nerve block (ONB) – If the pain extends to the back of the head, the doctor may perform this block. The procedure involves injecting a long-acting anesthetic (and possibly a steroid) into the back of the head. In a recent clinical study, the ONB was 100% effective for occipital neuralgia.
  • Trigger point injections (TPIs) – The doctor can inject trigger points with an anesthetic or other substance. This is usually used for myofascial syndrome, but can be effective for other causes of fascial pain. In one clinical study, the efficacy rate of TPIs was reported at 90-98%, with most patients having complete relief of pain.

Resources

Dhadwal, N, Hangan, MF, Dyo, FM, Zeman, R, & Li, J (2013). Tolerability and efficacy of long-term lidocaine trigger point injections in patients with chronic myofascial pain. International Journal of Physical Medicine and Rehabilitation.

Felisati G, Arnone F, Lozza P, et al. (2006). Sphenopalatine endoscopic ganglion block: A revision of a traditional technique for cluster headache. Laryngoscope,116:1447–1450.

Jurgens, TP, Muller, P, Seedorf, H et al. (2012). Occipital nerve block is effective in craniofacial neuralgias but not in idiopathic persistent facial pain. Journal of Headache Pain, 13(3), 199-213. doi:  10.1007/s10194-012-0417-x

Macfarlane TV, Blinkhorn AS, Davies RM et al. (2002). Oro-facial pain in the community: prevalence and associated impact. Com Dent Oral Epidemiology, 30(1), 52-60.