Facial pain causes, symptoms and therapy

Painful face can become a massive burden

Facial pain can affect the entire face as well as specific areas such as the cheek, forehead, jaw, or the oral environment. They are sometimes acute and of limited duration, in other cases suffer from permanently existing or recurring complaints. As a result, they can become a massive physical and mental burden and severely restrict the quality of life of patients. One of the most important causes of pain in the face is the "trigeminal neuralgia", which is characterized by sudden, single-sided and violent pain.

contents

• Painful face can become a massive burden
• There are a number of triggers into consideration
• Definition and symptoms
• Unilateral pain in the face
• Forms of trigeminal neuralgia
• Other forms of neuralgia
• Facial pain on the jaw
• Chronic facial complaints
• Pain in the face with a cold
• Cause facial paralysis
• shingles
• Other causes of facial pain
• Therapy for pain in the face
• Naturopathy with aching face

There are a number of triggers into consideration

There are a variety of triggers for facial pain, such as shingles, jaw and tooth problems, central nervous system disorders such as multiple sclerosis or sinusitis. In addition, facial pain can develop into chronic discomfort with no apparent cause. In this case, there is medical talk of a "persistent idiopathic facial pain", which predominantly affects middle-aged women and usually persists at a constant or varying intensity throughout the day.

Pain in the face can be muscular tension. (Image: 7activestudio / fotolia)

The treatment of the complaints is always based on the cause, which in addition to suitable drugs often, for example, physiotherapeutic and behavioral therapy methods and various stress reduction techniques are used.

Definition and symptoms

The term "facial pain" usually describes pain that affects either the entire face or individual areas such as cheeks, temples, nose, jaw, oral and ocular environment, but also the facial muscles or the skin. These can occur both on one side and 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, among others, to distinguish the complaints from headaches, because some forms such as e.g. Cluster headache or paroxysmal hemicrania have similar symptoms or cross over with facial pain.

In general, facial complaints can occur at any age and in very different degrees and intensities. Depending on the cause, for example, they are described as knocking, pulling, burning or stabbing, while other affected persons report a dull and oppressive feeling. Depending on the severity of the medical condition, a distinction is made between acute and chronic facial pain, and another distinguishing factor is whether the cause is recognizable (symptomatic pain) or not (idiopathic pain)..

Unilateral pain in the face

Among the most important pain triggers on the face are irritation of the supplying nerves, which are medically referred to as "neuralgia". Most commonly this is a so-called "trigeminal neuralgia", which, however, is relatively rare (about 4 per 100,000 people). This is a damage or irritation of the fifth cranial nerve (trigeminal nerve), which leads to pain attacks, which are among the strongest possible pain experiences.

The Trigeminusnerv ("Nervus trigeminus": Latin for "Triplet nerve") is responsible for the motor function of the masticatory muscles as well as for the sensitivity of the face. For this he splits after leaving the skull base in three branches (orbital, mandibular and maxillary nerve), which supply the different facial areas. In most cases, trigeminal neuralgia affects the second and / or third branch, causing the symptoms to occur mainly in the upper and lower jaws, nose, cheeks and chin, and sometimes also in the forehead.

Similar to the so-called cluster headache, the massive discomfort in most cases occurs in a flash on one side of the face and is described as "burning," "piercing," or similar to a "surge." Such a pain attack usually lasts only a few seconds, but can be repeated over the course of the day frequently and closely following each other. In addition, muscle cramps often occur on the affected side, redness, facial swelling and increased tears.

Frequently, the discomfort is caused by certain stimuli (triggers), e.g. a facial touch, chewing, talking or eating, in other cases they occur without a detectable trigger. Between the painful phases the affected persons usually experience no complaints, since the next attack can be triggered at any time unpredictable and even by a minimal movement, a trigeminal neuralgia usually means a massive burden and serious restriction of the quality of life.

In trigeminal neuralgia, the pain is often triggered by chewing or other stimuli. (Image: Nobilior / fotolia.com)

Accordingly, the disease in severe cases can have far-reaching consequences, for example, the unbearable pain can lead 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 arteriosclerosis, there is a pathological vascular-nerve contact through which the envelope of the nerve (myelin sheath ) is damaged. As a result, even the tiniest of stimuli are sufficient to trigger a spontaneous discharge of the nerve and thus severe unilateral facial discomfort, whereby here usually the second and / or third main branch are affected.

The extremely rare second form is called "symptomatic trigeminal neuralgia". In this case, the cause is in another disease such. Multiple sclerosis (MS), a stroke, vascular malformations or inflammatory diseases (shingles, Lyme disease). Possible triggers are benign nerve tumors (neurinomas) or secondary tumors of a malignant tumor (metastases), which exert pressure on the trigeminal nerve or lead to pathological vascular-nerve contact.

In this variant of trigeminal neuralgia, the first major branch or orbital nerve is also frequently affected, which is responsible for sensations of the forehead, eye socket and frontal sinus. Here, the pain usually persist between the attacks and often occur on both sides, also it is more common to sensory disorders area of ​​the affected nerve branch.

Other forms of neuralgia

In addition to trigeminal neuralgia, other forms of neuralgia can, in rare cases, lead to unpleasant facial pain. For example, if it is a so-called glossopharyngeal neuralgia, these are caused by the cranial nerve IX (glossopharyngeal nerve), which among other things is responsible for the sensitive supply of the pharynx, trachea, lower pharynx and esophagus as well as for the taste sensations in the posterior third of the tongue.

If this nerve is damaged, it causes pain in the area of ​​the throat, the tongue and the external auditory canal, which are usually very strong and seizure-like for a few seconds. Analogous to trigeminal neuralgia, they can be introduced spontaneously and without apparent cause, as well as by certain trigger factors, such as e.g. Cold drinks, coughing, yawning or eating are triggered.

In case of glossopharyngeal neuralgia further symptoms are possible, such as Circulatory insufficiency, low blood pressure or a slow pulse or heartbeat (bradycardia), as well as a temporary cardiac arrest (asystole), which untreated leads after a few minutes to death.

Problems in the tooth and jaw area can cause massive pain in the whole face. (Image: puhhha / fotolia.com)

Facial pain on the jaw

Cause of the complaints may 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), where the entire system of chewing is included with upper and lower jaw, temporomandibular joints, teeth and masticatory muscles.

Here it comes for example by Kiefer- or tooth misalignments ("wrong bite"), traumatic changes of the cervical spine or the temporomandibular joints (eg by a fall or traffic accident), different leg lengths or psychosocial factors such as stress to a dysregulation of the temporomandibular joint and the muscles involved and bones (upper and lower jaw or skull).

The result is a variety of complaints such. Toothache and jaw pain, problems opening and closing the mouth, cracking or rubbing of the jaw joint, excessive tooth wear, teeth grinding or tooth loosening.

In addition to the outside of the actual jaw area symptoms may occur, are typical of chronic headaches and migraines, facial pain, dizziness, earache and ear noises (tinnitus), sleep disorders, eye flares, back and knee pain and shoulder and neck tension.

Chronic facial complaints

Often it is a persistent idiopathic pain, also known as "atypical facial pain," which affects women between the ages of 30 and 50 years. Characteristic here is that there is no identifiable cause, so the symptoms are not attributable to either the typical nerve pain or another disease. As a trigger, therefore, for example, mental disorders are discussed, as well as some experts 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 injury or surgery to the ear, nose, throat, mouth, or jaw. Likewise, an invasive procedure on the teeth (e.g., extraction, root canal treatment) may result in a limited form of facial pain ("atypical odontalgia")..

Sufferers usually suffer from unilateral continuous pain during the day, which is described as burning, boring, pulsating and profound. At night, on the other hand, it usually decreases significantly or disappears completely, so that sleep is not impaired. Longer periods without discomfort are also possible; moreover, they can also occur on the other half of the face or on both sides during the course of the disease. Frequently the area of ​​the upper jaw, the eye, the nose and the forehead especially hurts, but it is also possible for further spreading, e.g. in the neck or the chin.

An operation in the tooth or mouth area can cause facial pain. (Image: madeinitaly4k / fotolia.com)

Unlike trigeminal neuralgia, atypical facial pain usually does not result in sudden pain attacks and additional emotional disorders, and there are no specific provocation factors that can trigger a spurt. Nevertheless, in some cases it happens that the pain is e.g. become stronger in stressful situations or by very cold temperatures.

Often, the atypical facial pain is also associated with mental health problems, especially depressive moods. In addition, some people suffer from other physical complaints, such as Back pain, neck pain or migraine.

Pain in the face with a cold

The symptoms can also occur as part of a cold, which is often referred to as a "flu infection". It is an acute infection of the upper respiratory tract, which is usually caused by pathogens such as adeno, rhino, or Coxsackieviren and is one of the most common diseases in general. Accordingly, in adults up to three and in preschool children even up to ten colds on average as "normal", only a higher number is usually spoken of a susceptibility to infection.

The pathogens are spread in most cases by droplet infection by these by coughing, sneezing, etc. get into the air and are inhaled in the sequence by other people. In addition, a "smear infection" is possible in which the pathogens either from directly to humans (for example, by the touch of an infected person) or indirectly via contaminated food, objects or drinking water from person to person. A typical way is, for example, the sneeze, in which the viruses on the hands and from there on all objects that are touched subsequently (doorknobs, stair railings, telephones, etc.). Now if another person touches the contaminated areas, it can come to a contagion, because of the hands reach the pathogens quickly on the mucous membranes (for example, by scratching the nose).

Since a successful defense of the pathogens can only succeed through an intact immune system, the risk of infection increases accordingly by immunocompromising factors such as hypothermia, stress or other diseases. In addition, being together with many people in closed rooms (for example, at work, kindergarten, etc.), especially in the cold season, can promote the development of a flu infection.

Typically, a cold will initially cause a dry throat and sore throat, and symptoms such as cough, runny nose, hoarseness, headache, fever, body aches, and general fatigue may also occur.

In the context of colds often piercing or stinging pain in the face. (Image: underdogstudios / fotolia.com)

It is also characterized by a feeling of tightness and / or facial pain, which are described as piercing and boring and usually usually strengthen by pressure or bending the head. These are particularly severe in sinusitis (sinusitis), which is one of the most common complications of a cold.

If the weakened defense also causes a bacterial infection ("superinfection"), an almond (tonsillitis) or middle ear infection develops more frequently, especially in children with colds. The spread of cold viruses on the throat, throat, bronchi, ear canal, etc. increases the risk of further complications such as bronchitis, lung or laryngitis.

Cause facial paralysis

Paralysis of the facial nerve (facial palsy) can be manifested by pain in the ear and face. For these, depending on the form, various causes such as e.g. an infection with Borrelia, an acute severe otitis media with bone infection, meningitis, a stroke or tumors in the brainstem into consideration. In most cases, however, facial paralysis occurs without any identifiable cause ("idiopathic facial paralysis" or "Bell palsy"), with the possible trigger being primarily a reactivated infection with the herpes simplex virus.

Typically, facial paralysis is characterized by hemipteral facial paralysis, which is typically manifested by sagging of the corner of the mouth. In addition, there are other symptoms such as a disturbed sense of taste, reduced tear and salivation, dry nasal membranes and hypersensitivity to noise (hyperacusis), in addition, the eyelids can often not be completely closed.

shingles

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

After surviving the disease, however, the virus remains partially "hidden" in the nerve tracts and can be activated in later life under certain conditions and cause an unpleasant shingles. However, the exact triggers for this reactivation are not yet clear. Most suspected are a weakened immune system (for example, in cancer, AIDS) as well as hereditary factors, stress, mental stress or skin irritation.

Characteristic of a herpes zoster is especially a painful, strip-like and itchy rash on one side of the body, which consists of red spots and small blisters. This vesicular eruption usually occurs on the chest and abdomen, the varicella-zoster viruses are in the cranial nerves, can cause shingles on the face.

However, the typical rash along the affected nerve usually does not appear until a few days after infection. Instead, the first signs are a general malaise, fatigue, severe fatigue and a slight fever, by the inflammation of the nerve occur severe pain and sometimes massive burning. If the herpes zoster affects the face, it can lead to numbness, tingling, toothache, visual and hearing impairment or facial muscle failure.

The characteristic vesicular eruption in a shingles usually occurs on the chest and abdomen, but can also affect the face. (Image: t0pkul3 / fotolia.com)

Other causes of facial pain

For the complaints, e.g. Chronic inflammatory diseases of the central nervous system such as multiple sclerosis be responsible, also comes the autoimmune thyroiditis Hashimoto's thyroiditis or the rheumatic vascular disease arteritis temporalis into consideration.

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 when parallel other typical heart attack symptoms such as sudden, strong, oppressive or burning chest pain occur, which can radiate not only in the jaw, but also in the upper abdomen, back, left arm or shoulder.

There are also other typical signs such as dizziness, chest tightness, blotches, cold sweats, nausea and vomiting, as well as severe anxiety and / or panic.

Danger: If there is a slightest suspicion of an infarction, it is necessary to immediately alert the ambulance (112 or the local emergency number) and, as necessary, first aid measures such as the patient's elevation, a CPR, removing cramped clothing ( eg tie, shirt buttons) etc..

Therapy for pain in the face

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

If the symptoms are chronic, staying in a pain clinic and the targeted reduction of stress can be very helpful. Likewise, sufferers can learn through behavioral therapy methods to reduce fears and to internalize coping strategies. In more severe cases, surgical measures may be indicated, but should only be made after a precise indication, in order to avoid health risks or an increase in the clinical picture.

For example, if diagnosis of exclusion diagnoses the relatively common persistent idiopathic facial pain, in many cases a combination of drug treatment and various relaxation techniques, such as e.g. proven autogenic training or meditation. In addition, special pain therapies and behavioral therapies can help to learn strategies for coping better and dealing with the pain more effectively. This is a central point in the treatment of atypical facial pain, because as a cure succeeds only in exceptional cases, the goal is mainly in the relief of the symptoms.

Relaxation techniques such as autogenic training or meditation are an important part of the treatment of idiopathic pain. (Image: fizkes / fotolia.com)

As part of the drug treatment are often prescribed so-called tricyclic antidepressants such as amitriptyline, which are also used in tension headaches. For these intervene on the one hand in the processing of pain in the brain and at the same time alleviate mental discomfort that afflicts a large number of those affected.

In some circumstances, anticonvulsants (anticonvulsants), such as Carbamazepine or gabapentin helpful, analgesics, however, are considered less effective. Likewise, experts such as from the "German Migraine and Headache Society" in the case of atypical pain on the face of surgical interventions, as these may cause further damage and cause a prolonged increase in pain.

Naturopathy with aching face

If conventional pain therapy is not sufficient or if severe drug side effects occur, alternative therapies, e.g. be effective in treating the massive pain of trigeminal neuralgia in many cases. Homoeopathic medicines come into consideration among other things, whereby alleviation of the symptoms in the case of this chronic disease can often only be achieved by a combination of several suitable medicines.

Belladonna (deadly nightshade) is often recommended, especially when the pain increases with pressure, touch, movement and outside, while it tends to decrease with rest and warmth. Belladonna patients often have a high red and hot head, in addition to a fast and powerful pulse, which leads to a sharp throbbing in the carotid artery. In general, persons who respond well to Belladonna are restless, agitated, and often anxious, which generally causes them to be poorly rested and often suffer from trouble falling asleep, restless sleep, and nightmares.

If the trigeminal neuralgia occurs on the left side and is characterized by recurring facial complaints that get worse in the first half of the day, but become lighter in the evening, Spigelia can help. However, if 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 which have proven useful in facial neuralgia but also in atypical facial pain, e.g. Magnesium phosphoricum, Cactus grandiflorus, Colocynthis or Cedron.

In the case of a trigeminal neuralgia, it must be discussed with a homeopath or naturopathic doctor, because especially with chronic pain therapy should never take place on one's own initiative. Instead, it is always neuralgic first neurological and / or dental clarify and in the next step, the / the appropriate (s) funds to seek out by an expert.

Above all, acupuncture can relieve chronic pain. (Photo: Kzenon / fotolia)

In addition, acupuncture can be used to treat trigeminal neuralgia. Here, however, acupuncture needles should not be stung in the affected side in case of severe attacks of pain, since the symptoms may increase or new seizures may be triggered. Instead, first the other side of the face or pain-relieving far points on the hands and feet are needled, in severe cases often a daily treatment is indicated, in which the needles are left for half an hour to hour in the skin.

If the severe pain is reduced after about six to eight sessions, the diseased half of the face is also treated, but first with few needles and a low stimulus intensity. From this point on, according to the German Acupuncture Society, medications often used until then can be slowly reduced, but a complete relief from the pain only occurs after 10 to 20 further treatments in many patients.

If a cold or sinusitis is the trigger for the aching face, various home remedies for colds can bring relief to the symptoms. Here are suitable, for example the Schüssler salts potassium chloratum (No. 4), Silicea (No. 11) and potassium sulfuricum (No. 6) as well as various applications of the proven hydrotherapy according to Pastor Sebastian Kneipp ("Kneipp cure").

Mostly heat is very beneficial, as are steam inhalations with sage or chamomile tea, table salt or essential oils (eucalyptus, peppermint) as an effective remedy to moisturize and liberate the respiratory tract. Heat is also often helpful in the case of cranio-mandibular dysfunction (CMD), for example by placing a moist, warm washcloth on the affected area on the face or by illuminating it with a red-light lamp. A warm bath can be very relaxing overall and thereby contribute to the relief of pain.

In general, it is advisable to take measures that strengthen the immune system for chronic pain. In this context, a healthy, well-balanced diet, adequate sleep and regular physical activity should be taken into account. Patients should abstain from nicotine and excessive alcohol intake in order to avoid exacerbating the symptoms.

Since facial pain is often an enormous burden and quality of life limitation, it is also very important for patients to find appropriate stress reduction procedures and measures. There are many ways to achieve relaxation and a strong, balanced "center," such as yoga, autogenic training, meditation, or progressive Jacobson muscle relaxation.

If there is a chronic pain, such as In the case of an atypical facial pain, a behavioral therapy is usually very useful to help those affected learn a better way to deal with the pain and thus achieve a better quality of life again. (nr, last updated on 16.2.2018)