Facial pain can be difficult to diagnose and treat, and requires an experienced, multidisciplinary team to relieve your pain. The Center for Facial Pain at the Neuroscience Institute draws from resources offered within Research Medical Center to identify the cause of your facial pain and find the treatment options that work for you.
What is Facial Pain?
Facial pain is pain felt in any part of the face, including the mouth and eyes. Most causes of facial pain are harmless and temporary, but severe or chronic facial pain can have many causes, some of them potentially serious. It’s important to be evaluated by a team experienced with facial pain and its possible causes.
What Causes Facial Pain?
Some causes of facial pain and their symptoms include:
- Trigeminal neuralgia. This condition affects the trigeminal nerve, which supplies sensation to your face. It may be caused by a blood vessel or tumor pressing on the nerve. This causes severe, electrical or shock-like pain, on one side of the face. The pain usually lasts less than a minute or two during each episode. It might go away, even for months, and return randomly.
- Occipital neuralgia. This condition involves the occipital nerves, which are nerves that run from the top of the spinal cord up through the scalp. When these nerves are injured or inflamed, you may feel sharp, jabbing, aching, or throbbing pain in the back of the head. You may feel the pain on one or both sides of your head and scalp and it may hurt to move your neck.
- Atypical facial pain. This refers to facial pain that has no identified cause. People often describe the pain as aching, burning or crushing. It is often misdiagnosed and can be challenging to treat.
- Post-shingles pain. People who have had shingles (a painful rash) sometimes develop chronic pain called postherpetic neuralgia. The pain is usually located in the same place or places where the shingles rash occurred. It can be intermittent or constant, and no one knows why some people get it and some don’t.
How is Facial Pain Diagnosed?
Because there are so many causes of facial pain, it can be challenging to diagnose. Our team will conduct a complete neurological examination and ask detailed questions about your symptoms and the location of your pain. We will also ask questions about your medical and family history. You will probably need an MRI (magnetic resonance imaging) or other type of scan to exclude tumors or other serious causes of your pain. Even if no cause can be identified, we can help you find relief.
How is Facial Pain Treated and Managed?
Your treatment will depend on the cause of your pain, its severity and other factors. Some treatment options we offer include:
- Balloon compression. In this minimally invasive procedure, a needle is inserted into the cheek and threaded to a part of the trigeminal nerve. A catheter with a tiny balloon on the tip is passed through the needle and positioned over the nerve. The balloon is inflated to squeeze part of the nerve, to damage it and keep it from sending pain signals to the face. The needle, catheter and balloon are then removed and patients return home on the same day as the procedure.
- Microvascular decompression. This open surgical procedure can relieve pressure on a nerve by inserting a tiny sponge between the nerve and the blood vessel that is pressing against it.
- Motor cortex stimulation. This surgical procedure places electrodes on the surface of the brain to control pain signals. It often helps when medication and other treatments have failed.
- Percutaneous radiofrequency trigeminal rhizotomy. This minimally invasive procedure can relieve nerve pain by destroying the part of the nerve that causes pain and suppressing the pain signal to your brain. The surgeon inserts a hollow needle through the skin of your cheek into the trigeminal nerve at the base of the skull. A small wire is passed through the needle to deliver heat that destroys some of the nerve fibers, which suppresses the nerve’s pain signals.
- Stereotactic radiosurgery (Gamma Knife®). Radiosurgery precisely delivers beams of radiation to a target location in the brain. For facial pain, the target is usually the trigeminal nerve where it enters the brain. The Gamma Knife can also treat tumors that are pressing on a nerve, without the need for open surgery.
- Subcutaneous stimulation. This minimally invasive technique targets small nerve fibers just beneath the skin. It can often relieve facial pain, including atypical facial pain that may not respond to other treatments.
- Surgical rhizotomy. This procedure severs selected nerve roots and can often bring relief of pain that doesn’t respond to other treatments.
When you’re learning about facial pain and what you can do about it, make sure your sources are reliable. Here are a few places to start:
- National Institute of Neurological Disorders and Stroke - trigeminal neuralgia information
- Facial Pain Association