Pain Centre

Updated 11 February 2013

Facial Pain

Face pain can be tingling and pounding or an extreme, acute tenderness in one or both sides of the face.

Definition

Face pain can be tingling and pounding or an extreme, acute tenderness in one or both sides of the face.

Possible causes


Facial pain may be caused by an infection in a part in the face, an injury or by a nerve syndrome. The origin of the pain may also be from somewhere else in the body (underlying pathology). The possible causes for facial pain are as follows:

1. Periorbital cellulitis (pre-septal)
This is an infection of the eye lid and erythema of the skin, which does not involve the eye itself. The eye will have normal movement. It is mostly caused by viral aetiology, but also has to be treated for a possible bacterial infection.

You should consult a general physician for treatment as soon as possible. He will prescribe oral antibiotics. You can use anti-inflammatory tablets at home to alleviate the symptoms.

2. Herpes simplex infection (cold sores)
This is a viral infection of which the symptoms are blistering and swelling of the affected area. It is extremely painful and can even cause a general feeling of tiredness and malaise. Facial pain can occur on one or both sides, depending on the severity of the outbreak.

You can treat the cold sores by applying acyclovir, four times daily. This product is available over the counter at any pharmacy. If the condition persists for longer than 7 days, you should consult a general physician, in order to get a prescription for oral anti-viral drugs.

3. Herpes zoster (shingles)
Shingles is a latent reaction of chicken pox. This virus lies dormant in the dorsal ganglia until it is reactivated by stress, trauma, medication and other possible systemic infections. The rash is confined to a specific dermatome (nerve area) on the face. It can therefore, appear anywhere on the face. This condition is extremely painful and cause systemic effects, such as malaise, fever and general sweating. You should consult your doctor for treatment. He will prescribe tricyclic, as well as anti-viral therapy that includes topical anti-viral cream and acyclovir (treatment for shingles) orally.

4. Injury to the face
Injury to the face can be mild or severe. Mild trauma will be trauma with bruising. This can be treated by applying an ice pack and taking pain tablets. Severe trauma to the face can include fractures of facial bones and deep lacerations to the skin. If you have severe facial trauma, you should immediately consult your doctor for stitching of deep lacerations and x-rays of facial bones.

5. Sinusitis and sinus infection
This will give you a deep sensation of pain over the sinuses and forehead. The pain will most commonly occur around the eyes and cheekbones. Pain is usually aggravated by palpitation of these areas, as well as bending forward. Sinusitis can be due to an allergy or an infection of the sinuses.

For allergic sinusitis that is often marked by itchy eyes, runny nose, sneezing and sinus pain, you can use over-the-counter drugs such as Lorano. If an infection is present, there will be a coloured mucus discharge. You will then have to consult your doctor for a prescription for oral antibiotics. In severe cases, where a polyp is the cause of the sinusitis, an operation will be needed to remove the polyp.

6. Tooth abscess
Pain and swelling on the affected side will be present. It is best to consult a dentist for treatment, as he/she will drain the abscess and prescribe oral antibiotics. You can take pain tablets at home to alleviate the symptoms.

7. Migraine
Migraine with an aura (neurological disturbance, typical visual, which occurs 30 to 60 minutes before the headache begins) is a typical/classical migraine. The pain is usually unilateral (one-sided) and throbbing, associated with nausea, vomiting, photophobia (sensitivity to light) and/or phonophobia (sensitivity to sound). Migraine without an aura, or common migraine, has no proceeding neurological symptoms. The pain is also unilateral and throbbing.

To prevent migraines, you can avoid common triggers such as alcohol, caffeine, red wine, cured meats, chocolate, monosodium glutamate, and foods containing tyramine or nitrate.

In the initial attack, it is best to consult your doctor, in order to start the correct treatment.

8. Myofascial pain syndrome
If you are experiencing chest pain associated with radiating facial pain, it is possible that you are having a heart attack. You should take a Disprin immediately and contact your physician urgently.

9. Temporomandibular joint pain
Pain will be experienced over the area of the joint, as well as the jaw, on one or both sides of the face. The pain will be aggravated by chewing or eating. You can take anti-inflammatories to alleviate the pain but it is advisable to contact an orthopaedic surgeon to have x-rays taken to assess the severity of the problem.

10. Tic aouloureux (Trigeminal Neuralgia)
It is sudden, severe, brief (seconds) stabbing pains in the destination of the fifth cranial nerve. It will be triggered by eating, tapping on the cheek, lips or mouth. During an episode, the face may grimace (tic douloureux).

When you experience the above, it will be best to consult your doctor. He/she might refer you for a neurological examination.

Written by Dr Anrich Burger, MB ChB (Stell)

 

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Dr Raath originally specialised and worked as an anaesthesiologist in private practice. In 2008 he obtained his Fellowship In Interventional Pain Practice and since then has operated the the Pain Clinic at the Netcare Jakaranda Hospital in Pretoria which treats all forms of chronic pain. Read more here.

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