Severe pain in the face is most often manifested with trigeminal neuralgia (it is also called trigeminal neuralgiaand I). This is a fairly common disease that affects to a greater extent the female population of the planet, especially the elderly. Most often, neuralgia has a right-sided localization. To impact on appearedThis pathology can be caused by both vascular and endocrine diseases, as well as allergies and psychogenic factors. This disease is considered an idiopathic disease. Trigeminal neuralgia occurs mainly due to compression of the trigeminal nerve. This can happen at two levels: intracranial and extracranial, so it can be of central and peripheral origin.
Status terminology
In medicine, such a condition is divided into primary and secondary, that is, symptomatic. The second is manifested in pathologies of the central nervous system. For example: stem stroke; multiple sclerosis; neoplasms of the pontocerebellar region.
Primary neuralgia occurs when the trigeminal nerve root is clamped at its place inexit from brain stem. It happensFor example, with the presence of convoluted loop of the superior cerebellar artery (diagnosed during surgery). However, in this case they speak of secondary neuralgia. But if the patient did not undergo any neurosurgical interventions, while there is an assumption of compression of the nerve root, then the diagnosis is made – primary neuralgia (secondary is diagnosed for those who underwent surgery).
Intracranial causes are called neoplasms in the posterior cranial fossa. Also, it can be an aneurysm of the basilar artery, meningitis, adhesions after infectious diseases and injuries.
Extracranial causes are congenital narrowing of holes and channels along the branches and local inflammatory processes. Severe facial pain can occur after tooth extraction, when the alveolar nerve is damaged – called odontogenic neuralgia, and also when metabolic disorders such as diabetes and gout, and at chronic infectious diseases such as tuberculosis, brucellosis, syphilis and herpetic infection. In rare cases, this condition is a symptom of multiple sclerosis.
Other causes of pain
The most rare neuralgia of individual zones of the trigeminal nerve, however, their pain level is much stronger – this is the syndrome of Charlin, Frey and the lingual nerve. In addition, this includes damage to the intermediate and facial nerve, vagus and glossopharyngeal. They manifest with characteristic symptoms and require urgent treatment (it is better to carry it out in the early stages of the development of the disease).
Also, severe pain is characteristic of postherpetic neuralgia, but unbearable pain can occur even during a depressive state (the latter case is called atypical facial pain).
Horton’s pain in the head is marked by strong boring pain sensations behind the eye, which radiates to the face.
Eye diseases, pathologies of the teeth and paranasal sinuses run in parallel with constant throbbing pain, which tends to increase. With cancerous neoplasms that germinate at the base of the skull, strong and regular pain sensations of the face also appear.
Incorrect bite leads to the appearance of temporomandibular joint syndrome, the pain of which is given to the cheek and temple. They often appear in front of the ear and become stronger during chewing.
During the examination, the pathological location of the joints and the restriction of jaw movement can be detected. In this case, ultrasound treatment and thermal procedures are used, as well as bite correction and special exercises that will help reduce pain.
Classification of such conditions:
- neuralgia – damage to the trigeminal nerve;
- temporomandibular joint syndrome;
- odontogenic bola;
- carotidynia;
- atypical facial pain.
How is the attack going?
A classic attack of neuralgia usually goes like this: there is a strong shooting pain, which the patient compares with a current discharge; the duration of the pain is two minutes; the duration of the interval between attacks directly depends on the stage of the disease, who caused it; the area of localization of pain will not change for several years; pain always has the same direction (it appears in one area and goes to another); there are zones on the patient’s face, with irritation of which characteristic pains appear; the presence of certain factors that affect the appearance of pain; the patient’s special behavior during an attack (he does not cry and does not move, but, on the contrary, freezes in the position in which the pain caught him – some begin to immediately rub the affected area); at the peak of pain, facial muscles may begin to twitch.
Symptoms of the phenomenon
A different type of disease is manifested by its characteristic symptoms, namely:
- Trigeminal neuralgia: manifests itself in the form of short, but strong unilateral shooting pains. An attack can begin when chewing, during a grimace, after a sharp shaking of the head, while talking, shaving, lightly touching the face, brushing your teeth.
- Temporomandibular joint syndrome: pain is localized in front of the ear, while giving to the temple and cheek.
- Odontogenic infection: occurs more often at night, characterized by throbbing pain covering the root of the tooth.
- Carotidinia: pain lasts for several hours, while they cover not only the face, but also the neck, lower jaw, ears and teeth. Pain may appear on palpation of the carotid artery.
- Atypical reaction: These are persistent pains that can be unilateral or bilateral. It can appear only on one part of the face, cover the neck. Increases during a stressful situation or in a warm room. It cannot be stopped with painkillers. It is necessary to carry out complex treatment. In this case, the nerve is decompressed in the facial canal with drugs (most often prednisolone and diuretics). Vasoactive treatment, B vitamins, physiotherapeutic procedures, a course of therapeutic massage and gymnastics are also prescribed.
- Charlin’s syndrome: manifested by severe eye pain that radiates to the back of the nose. Such an attack can last for several hours or even days. In this case, the patient develops severe lacrimation, photophobia, swelling. As therapeutic agents, analgesics and NSAIDs are used.
- Neuralgia of the lingual nerve: the diagnosis of this condition is based on the symptoms. For example, there are strong pain sensations of the face, tongue, part of the face may turn red, a dry cough begins – this happens after eating spicy food, with infectious pathologies and poisoning of the body. The attack lasts for several minutes. The patient may have a sharp drop in blood pressure and fainting may occur. The affected part of the tongue often loses sensation. With the progression of the disease, the feeling of pain also disappears. For treatment, analgesics, anticonvulsants, vitamins of group B are prescribed.
- Slader’s syndrome: there is a paroxysmal sharp pain near the eye and nasolabial triangle, while it can give to the back of the head, neck, shoulder blade, shoulder, arm and hand. The symptoms of this condition are as follows: half of the face becomes red, swelling of the face appears, profuse separation begins from one nostril, tears flow. The duration of the attack varies from a few minutes to one day.
- Myofascial facial syndrome: characterized by a complex of symptoms such as: neuralgia of the cranial nerve; violation of the movements of chewing muscles; taste change; malfunctions of the temporomandibular joint. Pain sensations are not limited only to the face, while their duration and intensity are varied. For example, the patient may experience only mild discomfort or suffer from unbearable pain. The feeling of pain can become stronger with severe fatigue, prolonged chewing and clenching of the jaws. In this case, symptoms such as: increased sweating; runny nose; vasospasm; dizziness; noise in ears; burning tongue.
If the above symptoms appear, it is necessary to consult with an experienced specialist (such diseases are treated by a neuropathologist).
If facial pain is of bone origin, then several conditions are the causes: progressive caries, pulpitis, periodontitis. They can provoke osteomyelitis – a purulent inflammatory process in the bones of the skull. In this case, pain will appear in the direction where the decay itself began. At the same time, body temperature increases, swelling of the skin and general weakness appear.
It is also provoked by fractures and injuries of the bones of the skull. With pains of only the skin, we can talk about their pathologies. For example, soft tissue contusion is considered a clear cause. As a result, edema and subcutaneous hemorrhages also occur.
Deep acne pimples are the cause of facial skin pain. Only an experienced doctor should treat this condition.
The most common reason is allergies. It is much more difficult to diagnose neurological symptoms, since pain in this situation will appear on the side where the nerve is affected (the right or left side of the face will hurt).
As treatment, medications, physiotherapy procedures, and a change in habitual lifestyle are prescribed. Some patients suffer from atypical facial pain – this means that there are no reasons for this condition, and even with a thorough study it is not possible to establish them.
Psychogenic pain appears during depression, hysteria, neurasthenia and other similar conditions. It is this type of pain that is most often diagnosed by a neurologist.
At the same time, pains are distinguished: hallucinogenic – occur with mental illness (schizophrenia, manic-depressive psychosis). In this case, it is difficult to understand what exactly is happening to the patient, because he describes completely insane symptoms.
Hysterical pains usually appear symmetrically, more often headaches begin in parallel with them (their intensity may vary throughout the day). The patient calls such pain “terrible and intolerable”, but they practically do not affect everyday life.
Pain in the face during depressive states is usually bilateral. In parallel, symptoms of depression also appear: inhibition of movements; downturned corners of the mouth and more.