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Facial pain: causes, symptoms and therapy

Facial pain: causes, symptoms and therapy


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Sore 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. Some of them are acute and of limited duration, in other cases sufferers suffer from persistent or recurring complaints. Accordingly, these can become a massive physical and psychological burden and significantly reduce the quality of life of the patients. One of the most important causes of pain in the face is "trigeminal neuralgia", which is characterized by sudden, one-sided and violent pain.

A number of triggers can be considered

A number of triggers for facial pain are considered, such as shingles, problems in the jaw and tooth area, diseases of the central nervous system such as multiple sclerosis or sinus infection. In addition, facial pain can develop into chronic complaints with no apparent cause. In this case, medically one speaks of a "persistent idiopathic facial pain", which mainly affects middle-aged women and usually persists during the day with constant or changing intensity.

The treatment of the complaints always depends on the cause, whereby in addition to suitable medications, physiotherapeutic and behavioral therapy methods and various stress relief techniques 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 cheeks, temples, nose, jaw, mouth and eye area, but also the facial muscles or skin. These can occur both on one side and in both halves of the face, and it is also possible that they radiate to the neck, shoulders or upper back. It is therefore important, among others, to differentiate the symptoms from headaches, because some forms such as Cluster headaches or the paroxysmal hemicrania show similar symptoms or cross over with those of facial pain.

Facial complaints can generally occur at any age and in very different forms and intensities. Depending on the cause, they are described as knocking, pulling, burning or stinging, for example, other people report a dull and oppressive feeling. Medically, a distinction is made between acute and chronic facial pain, and another point of distinction is whether the cause is recognizable (symptomatic pain) or not (idiopathic pain).

Unilateral pain in the face

The most important pain triggers on the face include irritation of the supplying nerves, which are medically referred to as "neuralgia". The most common is a so-called "trigeminal neuralgia", which, however, occurs relatively rarely overall (approx. 4 per 100,000 people). There is damage or irritation of the fifth cranial nerve (trigeminal nerve), which leads to pain attacks, which are among the strongest possible pain experiences.

The trigeminal nerve ("trigeminal nerve": Latin for "triplet nerve") is responsible for the motor function of the masticatory muscles and for the sensitivity of the face. For this purpose, it divides into three branches (orbital, mandible and maxillary nerve) after it exits the skull base, which supply the different facial areas. In most cases, trigeminal neuralgia affects the second and / or third branch, which means that the symptoms mainly appear in the upper and lower jaw, nose, cheeks and chin, and sometimes also in the area of ​​the forehead.

Similar to the so-called cluster headache, the massive complaints appear in a flash in most cases on one side of the face and are described as "burning", "stinging" or similar to a "power surge". Such a pain attack usually lasts only 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, swelling of the face and increased lacrimation.

The symptoms are often triggered by certain stimuli, such as a touch on 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 symptoms, but since the next attack can be triggered at any time unpredictably and with just a minimal movement, trigeminal neuralgia usually means a massive burden and a serious reduction in the quality of life.

Accordingly, the disease can have far-reaching consequences if the course is more severe, for example, because the unbearable pain can lead to depression, anxiety or a panic attack and, in serious cases, even thoughts of suicide.

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 arterial calcification (arteriosclerosis), there is an abnormal vascular-nerve contact, through which the covering of the nerve (myelin sheath ) is damaged. As a result, even the smallest stimuli are enough to trigger a spontaneous discharge of the nerve and thus violent one-sided facial complaints, which usually affect the second and / or third main branch.

The extremely rare second form is called "symptomatic trigeminal neuralgia". The cause of this is 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 daughter tumors of a malignant tumor (metastases), which exert pressure on the trigeminal nerve or lead to pathological vessel-nerve contact.

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

Other forms of neuralgia

In addition to trigeminal neuralgia, other forms of neuralgia can also lead to uncomfortable facial pain in rare cases. For example, if it is a so-called glossopharyngeal neuralgia, it originates from the cranial nerve IX (nerve glossopharyngeus), which is responsible, among other things, for the sensitive care of the throat, trachea, lower throat and esophagus, as well as for the taste sensations in the rear third of the tongue.

If this nerve is damaged, there is pain in the throat, tongue and external auditory canal, which is usually very strong and occurs like a fit for a few seconds. Analogous to trigeminal neuralgia, you can shoot in spontaneously and without a recognizable cause, as well as using certain trigger factors such as cold drinks, coughing, yawning or eating are triggered.

With glossopharyngeal neuralgia, further symptoms are possible, e.g. Weak circulation, low blood pressure or a slow pulse or heartbeat (bradycardia), as well as a temporary cardiac arrest (asystole), which leads to death after a few minutes if left untreated.

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) (lat. “Cranium” for skull and “mandibula” for lower jaw), whereby the entire chewing system is included with the upper and lower jaw, temporomandibular joints, teeth and chewing muscles.

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

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

In addition to the symptoms outside of the actual jaw area, symptoms include chronic headaches and migraines, facial pain, dizziness, ear pain 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, which is also known as "atypical facial pain" and particularly affects women aged 30 to 50 years. It is characteristic here that there is no recognizable cause, that is to say the complaints cannot be assigned to typical nerve pain or any other illness. For example, psychological disorders are discussed as triggers, and some experts suspect that the problems could be part of a general chronic pain disorder.

Another possible cause is disorders of the nervous system due to an injury or surgery in the ear, nose, throat, tooth, mouth or jaw area. Likewise, a limited form of facial pain can develop through an invasive intervention on the teeth (e.g. extraction, root canal treatment) ("atypical odontalgia").

Affected people usually suffer from one-sided permanent pain during the day, which is described as burning, boring, pulsating and profound. At night, however, it usually subsides significantly or disappears completely, so that sleep is not impaired. Longer phases without symptoms are also possible, and they can also appear on the other half of the face or on both sides in the course of the disease. The area of ​​the upper jaw, eye, nose and forehead often hurts, but a further spread is possible, e.g. in the neck or chin.

In contrast to trigeminal neuralgia, atypical facial pain does not usually lead to sudden pain attacks and additional emotional disorders, and there are no specific provocation factors that can trigger a relapse. Nevertheless, in some cases it happens that the pain e.g. become stronger in stressful situations or through very cold temperatures.

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

Face pain when cold

The complaints can also occur in the course of a cold, which is often also referred to as a "flu infection". This is an acute infection of the upper respiratory tract, which is mostly caused by pathogens such as adeno, rhino or coxsackie viruses 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 are considered “normal” on average, only with a higher number is usually said to be susceptible to infection.

In most cases, the pathogens are spread by droplet infection, in which they get into the air through coughing, sneezing, etc. and are subsequently 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 route 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 another person touches the contaminated areas, infection can occur, because the pathogens quickly reach the mucous membranes from the hands (e.g. by scratching the nose).

Since the pathogens can only be successfully warded off by an intact immune system, the risk of infection increases accordingly due to 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 favor the development of a flu-like infection, especially in the cold season.

A cold throat and a sore throat are typical for a cold, but later 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 is described as stinging and boring and is usually usually exacerbated by pressure or by bending the head. These are particularly pronounced in sinusitis, which is one of the most common complications of a cold.

If the weakened immune system also leads to a bacterial infection (“super infection”), especially in children with a cold, tonsillitis (tonsillitis) or otitis media develops. The spread of the cold viruses to the throat, throat, bronchial tubes, ear canal etc. increases the risk of further complications such as bronchitis, pneumonia or larynx.

Cause facial palsy

Facial nerve paralysis (facial palsy) can be manifested by pain in the ear and face. Depending on the shape, there are various causes for this, e.g. infection with borrelia, acute severe otitis media with inflammation of the bones, meningitis, a stroke or tumors in the brain stem. In most cases, facial palsy occurs without a recognizable cause ("idiopathic facial palsy" or "Bell's palsy"), whereby a reactivated infection with the herpes simplex virus is suspected as a possible trigger.

Facial paralysis is usually characterized by a half-sided paralysis of the face, which is typically manifested by the sagging of the corner of the mouth. In addition, there are other symptoms such as a disturbed taste, reduced tears and saliva, dry nasal mucous membranes and hypersensitivity to noise (hyperacusis), and the eyelids can often no longer be closed completely.

Shingles

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

After surviving the disease, however, the virus remains “hidden” in part in the nerve pathways and can therefore be reactivated under certain conditions later in life and cause unpleasant shingles. However, the exact triggers for this reactivation have not yet been clearly clarified. Above all, a weakened immune system (e.g. cancer, AIDS) as well as hereditary factors, stress, mental stress or skin irritation are suspected.

A herpes zoster is characterized above all by a painful, streaky and itchy rash on one side of the body, which consists of red spots and small blisters. This blistering rash usually occurs on the chest and abdomen. If the varicella zoster viruses are in the cranial nerves, shingles can also appear 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 sickness, exhaustion, severe tiredness and mild fever, the inflammation of the nerve causes severe pain and sometimes massive burning. If the herpes zoster affects the face, you may experience numbness, tingling, toothache, visual and hearing disorders or facial muscle loss.

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, in addition the autoimmune thyroid inflammation Hashimoto's thyroiditis or the rheumatic vascular disease arteritis temporalis come into consideration.

If the pain occurs in the area of ​​the jaw or 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, oppressive or burning chest pain appear in parallel, which can radiate not only into the jaw, but also into the upper abdomen, back, left arm or shoulder.

There are also other typical signs such as dizziness, chest tightness, paleness of the face, cold sweat, nausea and vomiting, and severe anxiety and / or panic.

Danger: If there is even the slightest suspicion of an infarct, it is important to immediately alert the emergency doctor (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 appear chronic, 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 a precise indication in order to avoid health risks or an intensification of the clinical picture.

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

Antispasmodic drugs (anticonvulsants) such as e.g. Carbamazepine or gabapentin are helpful, but pain relievers are considered to be ineffective. Experts such as from the "German Migraine and Headache Society" in the case of atypical facial pain from surgical interventions, as these can cause further damage and cause a persistent intensification of the pain.

Naturopathy for an aching face

If conventional pain therapy is not sufficient or if the medication causes severe side effects, alternative healing methods can be used, e.g. in many cases be an effective aid in the treatment of the massive pain of trigeminal neuralgia. Among other things, homeopathic medicines come into consideration here, whereby relief from the complaints in the case of this chronic illness can often only be achieved by a combination of several suitable medications.

Belladonna is often recommended, especially when the pain increases when pressure, touch, movement and outdoors, while it tends to decrease when it is calm and warm. Belladonna patients often have a very red and hot head, in addition there is a fast and strong pulse, which leads to a violent throbbing in the carotid artery. Generally, people who respond well to Belladonna are restless, excited 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, which get worse and worse in the first half of the day but become easier again 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. There are also a number of other homeopathic remedies that have proven effective for facial neuralgia, but also for atypical facial pain, e.g. Magnesium phosphoricum, Cactus grandiflorus, Colocynthis or Cedron.

In the case of trigeminal neuralgia, it is absolutely necessary to discuss with a homeopath or naturopathic doctor whether or which remedy is appropriate in individual cases, because therapy for chronic pain should never be given on your own. Instead, it is always necessary to first clarify the neurological and / or dental neuralgia and to have the appropriate agent (s) selected by an expert in the next step.

In addition, acupuncture can be used effectively in the treatment of trigeminal neuralgia. In the case of severe seizure-like pain, however, no acupuncture needles should be inserted into the affected side, since the complaints increase or new seizures can be triggered. Instead, the other side of the face or pain-relieving distant points on the hands and feet are needled, whereby in severe cases a 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 subsides after about six to eight sessions, the sick half of the face is also treated, but initially with a few needles and a low level of irritation. From this point in time, according to the German Acupuncture Society, medication often used until then can be slowly reduced, but in many patients complete relief from pain only occurs after 10 to 20 further treatments.

If a cold or sinus infection is the trigger for the painful face, various home remedies for runny nose can relieve the symptoms, among other things. Here are e.g. the Schüssler salts Kalium chloratum (No. 4), Silicea (No. 11) and Kalium sulfuricum (No. 6) as well as various applications of proven hydrotherapy according to Pastor Sebastian Kneipp (“Kneipp cure”).

Mostly, heat is very beneficial, and steam inhalations with sage or chamomile tea, table salt or essential oils (e.g. eucalyptus, peppermint) are also effective remedies to moisturize and clear the airways. Heat also 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. A warm bath can be very relaxing overall and thus help relieve pain.

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

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

If you have chronic pain, such as In the case of atypical facial pain, behavioral therapy is usually also very useful, through which those affected can learn how to better deal with the pain and thereby achieve a better quality of life. (No)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Social Science Nina Reese

Swell:

  • 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 02.09.2019), MSD
  • Michael Rubin: Facial Palsy, MSD Manual, (accessed 02.09.2019), MSD


Video: Living with Trigeminal Neuralgia (September 2022).


Comments:

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