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Facial Pain, Spasm

Facial Pain, Spasm

Facial pain has a long list of possible causes. The common causes are often not serious, but it is essential not to miss those conditions that require urgent treatment.


What causes facial pain?

Common causes of chronic facial pain are infection, sinusitis, trauma, dental & jaw alignment problems and migraine as well as neurological conditions such as tumour related pain, Trigeminal Neuralgia & Glossopharyngeal Neuralgia.


Trigeminal neuralgia

The trigeminal nerve is one of the largest nerves in the head (also called 5th cranial nerve), there is one on each side and they supply most of the sensation to the face.


Trigeminal neuralgia is a disorder, which causes intermittent episodes of sudden, intense, stabbing pain in the face originating from the Trigeminal nerve. Each burst of pain lasts for only a few seconds, but there can be many of these bursts of pain in quick succession. They may come and go throughout the day and last for days, weeks, or months, and then disappear for months or years.


Pain may be triggered by everyday activities such as talking, eating, brushing your teeth or touching the face. The pain can be felt on the skin or in the mouth and teeth and usually only affects one side of the face. Although it is most commonly felt in the jaw and cheek area, it may cover the whole of one side of the face depending on which parts of the nerve are affected.


Trigeminal neuralgia affects women more commonly than men and usually occurs between the ages of 50 – 70. It can occur in younger people but is rare below the age of 40.


Some cases of trigeminal neuralgia are thought to be caused by an abnormal blood vessel pressing on the trigeminal nerve, usually deep within the skull where the nerve attaches at the base of the brain. It is believed this irritates the nerve, triggering the pain. However, it is not known why blood vessels should start to press on the trigeminal nerve in later life.


Trigeminal neuralgia may also be caused by the development of a tumour pressing on the Trigeminal nerve.


Glossopharyngeal neuralgia

This is a very rare condition, similar to trigeminal neuralgia, but affecting a different nerve. The pain is usually felt at the base of the tongue, back of the throat and sometimes may radiate to the ear. It affects only one side of the face and the pain may be triggered by touching the ear or swallowing. It is usually treated with the same medications as trigeminal neuralgia.


How is the cause of facial pain diagnosed?

An MRI scan will usually show whether or not pressure from a blood vessel or tumour is the route cause of facial pain.


Medical Treatment

Treatment is usually with medication at first, most commonly the anti-convulsant Carbamazepine.


Surgical Treatment

If medication does not control the pain, neurosurgeons can sometimes perform surgery to relieve the pressure on the nerve with a Microvascular Decompression procedure.

NB: Please see additional information on this Microvascular Decompression under our surgery section.


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Brain and neurology guide: conditions and treatments