Author: Diana Tolentino, MD, FPSO-HNS
Facial Pain can be described as throbbing, sharp, intense, stabbing, cramping, and burning.
It is important to seek medical attention when encountering these conditions to prevent
complications and address underlying conditions that can make the pain worse. The intensity of the pain is often communicated by the patient to the physician using pain scales as shown below. These help the doctor in the management and monitoring of the condition.
Whatever the characteristics are facial pain is usually attributed to one or more of the following causes:
Trauma
Trauma due to motor vehicular accidents, mauling, or a fall can directly lead to facial pain. It is important to seek first aid and stabilize the airway before seeking medical attention. Fractures, especially those involving the maxillofacial buttresses, typically require surgery.
Headaches
Headaches can be categorized as primary or secondary caused by other diseases or conditions.
Primary headaches include: (1) tension-type headaches: dull or aching tightness around the head and caused by stress or muscle tension, (2) migraine headaches: often one-sided and described as pulsating, commonly associated with nausea/
vomiting, and (3) cluster headaches: severe and sharp pain that is on one side of the head or around the eye, commonly associated with nasal congestion or epiphora (tearing). Secondary headaches are caused by sinusitis, conditions of the cervical spine, medication overuse, high blood pressure, dehydration, and other underlying medical conditions.
Sinusitis or Sinus Infections
Chronic pressure and inflammation of the sinuses can lead to facial pain usually localized to the forehead, cheeks, behind and around the eyes. The affected areas may be tender to touch, usually associated with nasal congestion, runny nose, hyponasal speech and other flu-like symptoms.
Sinus headaches can also be caused by allergies, nasal polyps, and deviated nasal septum.
TMJ Disorders
The temporomandibular joint (TMJ) helps in chewing, speaking, swallowing, mouth movements like opening/closing and side to side movement.
TMJ dysfunction can be caused by problems in the TMJ and the surrounding muscles of mastication. Management usually includes medication, mouth guards, physical therapy, or surgery.
Trigeminal Neuralgia
This medical condition is usually described as sudden and severe facial
pain that is sharp and shooting, caused by damage to the trigeminal nerve (or the fifth cranial nerve).
Treatment includes medications, pain relievers, nerve blocks, and sometimes, surgery. Other facial pain caused by nerve injuries are characterized as burning or tingling sensations.
Dental Pain
Problems like tooth decay, cavities, dental infection, and gum disease can cause pain radiating to the face.
If left untreated, this can potentially affect other fascial spaces and can lead to deleterious sequelae. A multidisciplinary team consisting of dentists, Oromaxillofacial specialists, and otorhinolaryngologists (ENT) can dramatically manage complications of facial pain due to dental conditions.
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