Facial Pain Care
At UC San Diego Health, our world-renowned specialists offer a multidisciplinary approach to facial pain.
Facial pain can come from a variety of sources, and diagnosing the cause is sometimes very complex. Therefore, patients often see many types of doctors, including dentists, ear, nose and throat (ENT) specialists, pain specialists, neurosurgeons and neurologists. This can be confusing and time-consuming.
To determine the right treatment, we use a systematic approach to find the source of the pain, beginning with a detailed history and targeted physical examination, which may lead to specialized testing.
Common Causes of Facial Pain
The trigeminal nerve, or Cranial Nerve Number 5, is the nerve that controls light touch, as well as the transmission of pain and temperature to various regions of the head and face.
Trigeminal neuralgia (TN) is a syndrome that leads to facial pain, with between 4.5 and 28.9 new cases per 100,000 people each year. Because it is often confused with other types of facial pain syndromes, TN is overdiagnosed and, therefore, sometimes mistreated. There are two types of TN:
Classic Trigeminal Neuralgia (TN)
Also known as tic douloureux, classic TN often produces recurrent and abrupt "electric shock-like" pain. TN affects one or more branches of the trigeminal nerve, most commonly in the second or third division. Classic trigeminal neuralgia is more frequent in older populations, often with the first attack occurring in the late 50s or 60s — it is rare before the age of 40. It is usually caused by compression of a blood vessel at the root entry zone of the trigeminal nerve in the brain.
- Pain may last for a few seconds or, in some cases, persist for up to two minutes and usually occurs only on one side of the face.
- The duration of pain attacks can change over time and become more prolonged and severe. Between those pain attacks, most patients do not report any pain.
- Typical trigeminal neuralgia pain is often triggered by a light touch of the face (such as by applying makeup or shaving), brushing teeth, and chewing, among other things.
- Patients complete a questionnaire, and a specialist takes a detailed history and conducts a physical exam.
- Our radiologists perform a specialized set of imaging sequences to confirm the diagnosis of trigeminal neuralgia and, more importantly, to rule out secondary trigeminal neuralgia-like tumors.
Secondary Trigeminal Neuralgia
While classic trigeminal neuralgia can occur in patients below age 50, other diagnoses causing facial pain, specifically multiple sclerosis, can be considered in younger patients.
- This type of facial pain often shares many common characteristics with classic trigeminal neuralgia, including severe, sharp, electric pain that is worsened by a light touch of the face.
- Patients who also complain of sensory symptoms, like numbness and tingling, are more likely to have secondary trigeminal neuralgia.
- Depending on the history and examination, tests may include a different type of specialized brain MRI, a CT scan of the face and sinuses, and a special set of blood tests.