Facial Pain Awareness Month

For facial pain awareness month we look at the different debilitating and complex symptoms of facial pain. At the Trigeminal Neuralgia Association we are acutely aware of the effect these have on quality of life and the diagnostic challenges healthcare professionals face. From common conditions such as migraine and sinusitis to rare disorders like trigeminal neuralgia and Tolosa-Hunt syndrome, the causes of facial pain are diverse and often overlap. Understanding these conditions is crucial for timely diagnosis and effective treatment.

This guide, developed for facial pain awareness month, is designed to give you an insight into the different causes of face pain. In addition to traditional medical treatments, we explore a range of alternative therapies that can complement conventional care, offering patients holistic approaches to managing chronic pain. From acupuncture and physical therapy to dietary supplements and mindfulness practices, we aim to provide a balanced view of all available options.

Given the potential for severe complications—such as vision loss in giant cell arteritis or persistent nerve pain in trigeminal neuralgia—early recognition and multidisciplinary management are essential.

Index of conditions

In this blog we will look at the following causes of facial pain:

1. Atypical Facial Pain (Persistent Idiopathic Facial Pain)
2. Bell’s Palsy
3. Burning Mouth Syndrome
4. Cluster Headaches
5. Dental Abscess
6. Dental Caries (Tooth Decay)
7. Eagle Syndrome
8. Ernest Syndrome
9. Frey’s Syndrome
10. Giant Cell Arteritis (Temporal Arteritis)
11. Glossopharyngeal Neuralgia
12. Hemicrania Continua
13. Herpes Zoster (Shingles) Affecting the Face
14. Idiopathic Intracranial Hypertension (IIH)
15. Jaw Claudication
16. Migraine
17. Myofascial Pain Syndrome
18. Nummular Headache
19. Occipital Neuralgia
20. Oral Cancer
21. Osteomyelitis of the Jaw
22. Parotitis
23. Paroxysmal Hemicrania
24. Peripheral Neuropathy
25. Postherpetic Neuralgia
26. Raeder’s Syndrome
27. Ramsay Hunt Syndrome
28. Short-lasting Unilateral Neuralgiform Headache Attacks with Conjunctival Injection and Tearing (SUNCT)
29. Short-lasting Unilateral Neuralgiform Headache Attacks with Autonomic Symptoms (SUNA)
30. Sarcoidosis
31. Sialolithiasis (Salivary Gland Stones)
32. Sinusitis
33. Sluder’s Neuralgia (Sphenopalatine Neuralgia)
34. Temporomandibular Joint (TMJ) Disorder
35. Tension-Type Headache
36. Tolosa-Hunt Syndrome
37. Trigeminal Neuralgia

We have discussed Trigeminal Neuralgia here but we have much more detail listed on our webpage.

 

1. Atypical Facial Pain (Persistent Idiopathic Facial Pain)

Description:
Atypical facial pain, also called persistent idiopathic facial pain, is chronic, poorly localised facial pain, often without an identifiable cause. The pain tends to be constant and non-specific, unlike the sharp, episodic pain seen in trigeminal neuralgia.

Key Symptoms:

• Persistent, aching pain that may shift location or radiate across the face.
• Pain is usually unilateral but can be bilateral.
• Dull, aching sensation without a clear cause.

Conventional Treatments:

• Tricyclic antidepressants (e.g., amitriptyline) to manage chronic pain.
• Anticonvulsants (e.g., gabapentin or pregabalin) to control neuropathic pain.
• Cognitive Behavioural Therapy (CBT) or psychotherapy to manage pain perception.

Alternative Therapies:

• Mindfulness-Based Stress Reduction (MBSR): Helps patients manage chronic pain through mindfulness practices.
• Acupuncture: May provide relief for some patients through stimulation of nerve pathways.
• Capsaicin Cream: Capsaicin can desensitise nerve endings in chronic pain conditions, though effectiveness is limited in idiopathic facial pain.

2. Bell’s Palsy

Description:
Bell’s Palsy is an acute condition causing sudden weakness or paralysis of the muscles on one side of the face due to inflammation or compression of the facial nerve (cranial nerve VII). It often resolves spontaneously, although some cases require treatment for recovery.

Key Symptoms:

• Sudden onset of facial drooping, usually unilateral.
• Inability to close the eye on the affected side.
• Loss of taste in the front two-thirds of the tongue.

Conventional Treatments:

• Corticosteroids (e.g., prednisolone) to reduce inflammation.
• Antiviral medications (e.g., acyclovir) if a viral infection is suspected, particularly herpes simplex virus.
• Physical therapy or facial exercises to aid muscle recovery.

Alternative Therapies:

• Acupuncture: Some patients use acupuncture to improve nerve function and speed recovery.
• Facial Massage: Regular massage may help improve circulation and prevent muscle atrophy.
• Vitamin B Complex: B vitamins, particularly B12, may support nerve regeneration.

3. Burning Mouth Syndrome

Description:
Burning Mouth Syndrome (BMS) is characterised by a persistent burning sensation in the mouth, typically without any visible signs of irritation. It primarily affects postmenopausal women and is thought to be related to nerve dysfunction.

Key Symptoms:

• Burning or scalding sensation in the mouth, often affecting the tongue, lips, and palate.
• Dry mouth (xerostomia) and altered taste (dysgeusia).

Conventional Treatments:

• Clonazepam (a benzodiazepine) for pain relief.
• Tricyclic antidepressants (e.g., amitriptyline) or gabapentin for chronic pain management.
• Artificial saliva products or saliva stimulants for dry mouth.

Alternative Therapies:

• Alpha-Lipoic Acid (ALA): Antioxidant therapy that has shown some efficacy in reducing BMS symptoms.
• Capsaicin Lozenges: Used in low doses to desensitise the nerves and reduce burning sensations.
• Mind-Body Therapy: Mindfulness and relaxation techniques may help manage symptoms.

4. Cluster Headaches

Description:
Cluster headaches are extremely painful, with sharp, stabbing pain that occurs around one eye or temple in cyclical patterns known as “clusters.”

Key Symptoms:

• Intense, one-sided pain, usually around the eye.
• Redness, tearing, or nasal congestion on the affected side.
• Attacks last between 15 minutes to 3 hours, often occurring multiple times a day during a cluster period.

Conventional Treatments:

• High-flow oxygen therapy (100%) to abort acute attacks.
• Triptans (e.g., sumatriptan) via nasal spray or injection.
• Verapamil is often used as a preventive therapy to reduce the frequency of attacks.

Alternative Therapies:

• Melatonin Supplements: Some patients benefit from melatonin, particularly in managing circadian rhythm-related cluster headaches.
• Capsaicin Nasal Spray: Studies suggest capsaicin nasal spray may reduce the frequency of attacks.
• Biofeedback Therapy: Biofeedback techniques can help control pain by teaching patients to regulate physiological functions, such as blood flow.

5. Dental Abscess

Description:
A dental abscess is a pocket of pus caused by a bacterial infection in the tooth or surrounding tissues. If left untreated, it can spread to other parts of the body, causing serious complications.

Key Symptoms:

• Severe, throbbing toothache.
• Swelling in the face, gums, or neck.
• Sensitivity to hot or cold temperatures.

Conventional Treatments:

• Drainage of the abscess through incision or root canal.
• Antibiotics to treat the infection.
• Tooth extraction in severe or recurrent cases.

Alternative Therapies:

• Saltwater Rinse: A natural way to reduce inflammation and promote healing.
• Oil Pulling: While lacking strong evidence, some patients use coconut oil pulling to reduce bacterial load and inflammation.
• Herbal Remedies: Clove oil is sometimes applied as a natural analgesic for dental pain.

6. Dental Caries (Tooth Decay)

Description:
Dental caries, or tooth decay, is caused by bacteria producing acids that erode the tooth enamel, eventually leading to cavities and infection if left untreated.

Key Symptoms:

• Tooth sensitivity to sweet, hot, or cold substances.
• Visible pits or holes in the teeth.
• Persistent toothache or pain when biting.

Conventional Treatments:

• Fillings to restore cavities.
• Root canal therapy for advanced decay or infection.
• Fluoride treatments to strengthen enamel.

Alternative Therapies:

• Xylitol Gum: Chewing xylitol gum after meals can help reduce the bacterial load and prevent cavities.
• Herbal Mouth Rinses: Mouth rinses containing herbal ingredients like tea tree oil or clove oil are sometimes used to reduce oral bacteria.

7. Eagle Syndrome

Description:
Eagle Syndrome is caused by an elongated styloid process or calcified stylohyoid ligament, which can result in throat and facial pain, particularly when turning the head or swallowing.

Key Symptoms:

• Pain radiating to the throat and ear.
• Sensation of something stuck in the throat.
• Pain triggered by swallowing or turning the head.

Conventional Treatments:

• NSAIDs to reduce inflammation and manage pain.
• Surgical shortening of the styloid process in severe cases.

Alternative Therapies:

• Physical Therapy: Strengthening and stretching exercises may help relieve some of the muscular tension around the neck.
• Botox Injections: Can be used to relax muscles in the throat and jaw that contribute to pain.

8. Ernest Syndrome

Description:
Ernest Syndrome is caused by inflammation or damage to the stylomandibular ligament, which connects the jaw to the skull. It results in pain that can be misdiagnosed as temporomandibular joint (TMJ) disorder, but the pain is typically focused around the ear, jaw, and neck.

Key Symptoms:

• Pain in the jaw, ear, and neck region.
• Difficulty chewing or speaking.
• Tenderness along the stylomandibular ligament.

Conventional Treatments:

• NSAIDs (e.g., ibuprofen) to reduce pain and inflammation.
• Trigger point injections with anaesthetic to relieve pain.
• Physical therapy to release tension and improve muscle balance.

Alternative Therapies:

• Acupuncture: May help reduce muscle tension and pain associated with ligament strain.
• Chiropractic Care: Realigning the neck and jaw may provide relief in some patients.
• Myofascial Release Therapy: Helps to relax and stretch the muscles around the affected area.

9. Frey’s Syndrome

Description:
Frey’s Syndrome, or gustatory sweating, is a condition that occurs after surgery or trauma to the parotid gland. It leads to sweating and flushing on the cheek during meals due to miswiring of nerves involved in salivation.

Key Symptoms:

• Sweating and flushing on one side of the face during eating.
• Pain near the parotid gland, particularly during meals.

Conventional Treatments:

• Botox injections to block the nerves responsible for sweating.
• Topical anticholinergic creams to reduce sweating.

Alternative Therapies:

• Acupuncture: Some patients report relief from gustatory sweating using acupuncture, although evidence is anecdotal.
• Dietary Adjustments: Avoiding spicy or acidic foods may help reduce symptoms.
• Biofeedback Therapy: Some patients benefit from learning techniques to control physiological responses like sweating.

10. Giant Cell Arteritis (Temporal Arteritis)

Description:
Giant Cell Arteritis (GCA) is an inflammatory condition affecting the large and medium arteries, typically those in the head and neck. Left untreated, it can lead to serious complications such as vision loss or stroke.

Key Symptoms:

• Severe, throbbing headache, usually in the temples.
• Scalp tenderness, particularly when brushing hair or touching the area.
• Jaw pain or claudication when chewing.
• Visual disturbances, such as blurred or double vision.

Conventional Treatments:

• High-dose corticosteroids (e.g., prednisolone) are the mainstay of treatment to reduce inflammation and prevent complications like blindness.
• Tocilizumab (an IL-6 receptor antagonist) is sometimes used to reduce steroid use and manage long-term cases.
• Low-dose aspirin to reduce the risk of stroke.

Alternative Therapies:

• Anti-inflammatory diet: A diet rich in omega-3 fatty acids and antioxidants (from fish, nuts, and vegetables) may help reduce systemic inflammation.
• Vitamin D and calcium supplements: Recommended for patients on long-term corticosteroid therapy to prevent osteoporosis.
• Mindfulness-based therapy: Helps patients manage stress, which may exacerbate inflammatory conditions.

11. Glossopharyngeal Neuralgia

Description:
Glossopharyngeal Neuralgia is a rare condition that causes sharp, shooting pain in the areas innervated by the glossopharyngeal nerve, including the throat, back of the tongue, tonsils, and ear. The pain is typically triggered by swallowing, speaking, or coughing.

Key Symptoms:

• Sudden, severe pain in the throat, back of the tongue, or ear.
• Pain triggered by swallowing, coughing, or talking.
• Episodes last for seconds but can be very debilitating.

Conventional Treatments:

• Anticonvulsants (e.g., carbamazepine or gabapentin) to control neuropathic pain.
• Microvascular decompression (MVD): A surgical option for patients who do not respond to medications. It involves relieving pressure on the glossopharyngeal nerve.
• Nerve blocks or radiofrequency ablation may be used in severe cases.

Alternative Therapies:

• Capsaicin cream: Applied topically to reduce nerve sensitivity.
• Acupuncture: Acupuncture may provide relief for nerve pain by stimulating circulation and reducing inflammation.
• Herbal Supplements: Some patients use turmeric or curcumin due to their anti-inflammatory properties, although evidence specific to glossopharyngeal neuralgia is limited.

12. Hemicrania Continua

Description:
Hemicrania Continua is a chronic headache disorder causing continuous, moderate pain on one side of the head, with periods of severe exacerbations. It is unique in that it responds completely to indomethacin, a nonsteroidal anti-inflammatory drug (NSAID).

Key Symptoms:

• Constant, unilateral headache, usually around the eye or temple.
• Pain exacerbated by physical activity.
• Autonomic symptoms like tearing, nasal congestion, or eyelid drooping.

Conventional Treatments:

• Indomethacin is the definitive treatment, offering near-total pain relief.
• For patients who cannot tolerate indomethacin, COX-2 inhibitors or topiramate may be used.

Alternative Therapies:

• Acupuncture: Can help reduce headache intensity and frequency.
• Magnesium Supplements: May reduce headache severity, particularly in chronic headache disorders.
• Biofeedback Therapy: Effective in managing stress-related muscle tension, which can exacerbate pain.

13. Herpes Zoster (Shingles) Affecting the Face

Description:
Herpes Zoster, or shingles, is caused by the reactivation of the varicella-zoster virus, the same virus that causes chickenpox. When it affects the facial nerves, it can cause a painful rash and lead to complications such as postherpetic neuralgia.

Key Symptoms:

• Painful, blistering rash typically following the distribution of the trigeminal nerve.
• Persistent nerve pain even after the rash resolves (postherpetic neuralgia).
• Eye involvement (herpes zoster ophthalmicus) can lead to vision complications.

Conventional Treatments:

• Antiviral medications (e.g., acyclovir or valacyclovir) to reduce the severity and duration of the outbreak.
• Corticosteroids to reduce inflammation, especially if the eye is involved.
• Pain management with gabapentin or opioids, particularly for postherpetic neuralgia.

Alternative Therapies:

• Capsaicin Cream: Applied topically to reduce nerve pain.
• Vitamin C Therapy: Some clinicians advocate high-dose vitamin C during an outbreak to boost immune function.
• Oatmeal Baths: Soothes skin irritation and reduces itching during the acute phase.

14. Idiopathic Intracranial Hypertension (IIH)

Description:
Idiopathic Intracranial Hypertension (IIH) is a condition in which pressure inside the skull increases without an obvious cause. This pressure can lead to headaches, vision problems, and occasionally facial pain due to cranial nerve compression.

Key Symptoms:

• Persistent headaches, often worse in the morning.
• Transient visual disturbances, including blurred vision and “graying out.”
• Papilledema (swelling of the optic disc), detected during an eye exam.

Conventional Treatments:

• Acetazolamide, a diuretic, to reduce cerebrospinal fluid production.
• Weight loss is recommended for overweight individuals, as it can significantly improve symptoms.
• Surgical options such as shunting or optic nerve sheath fenestration in severe cases.

Alternative Therapies:

• Low-Sodium Diet: Helps reduce fluid retention and may alleviate symptoms.
• Mindfulness-Based Stress Reduction (MBSR): Helps patients manage stress and reduce headache frequency.
• Omega-3 Fatty Acids: Some studies suggest that omega-3 supplementation may improve vascular health and reduce intracranial pressure.

15. Jaw Claudication

Description:
Jaw claudication refers to pain or fatigue in the jaw muscles while chewing, most commonly associated with Giant Cell Arteritis (GCA). The pain results from reduced blood flow to the muscles of the jaw due to inflammation in the arteries.

Key Symptoms:

• Pain or tiredness in the jaw after chewing.
• Difficulty eating tough or large amounts of food.
• Associated with other symptoms of GCA, such as headaches and scalp tenderness.

Conventional Treatments:

• High-dose corticosteroids to treat the underlying cause (GCA) and prevent complications such as vision loss.
• Low-dose aspirin to reduce the risk of vascular complications.

Alternative Therapies:

• Dietary Changes: Eating soft foods and smaller meals to reduce jaw strain.
• Facial Massage: Gently massaging the jaw muscles can help reduce tension and discomfort.
• Omega-3 Supplements: Known for their anti-inflammatory properties, omega-3s may help reduce vascular inflammation.

16. Migraine

Description:
Migraine is a common, debilitating type of headache often accompanied by nausea, vomiting, and sensitivity to light and sound. It may be preceded by an aura, a set of visual or sensory disturbances that signal the onset of a migraine.

Key Symptoms:

• Severe, unilateral throbbing headache.
• Nausea and vomiting.
• Sensitivity to light (photophobia) and sound (phonophobia).
• Aura (visual disturbances like flashing lights or blind spots) in some cases.

Conventional Treatments:

• Triptans (e.g., sumatriptan) to abort acute migraine attacks.
• NSAIDs (e.g., ibuprofen) for pain relief.
• Beta-blockers (e.g., propranolol) or anticonvulsants (e.g., topiramate) for preventive therapy in chronic cases.

Alternative Therapies:

• Magnesium Supplements: Magnesium deficiency has been linked to migraines, and supplementation may reduce the frequency and severity of attacks.
• Acupuncture: May help reduce the intensity and frequency of migraines by stimulating nerve pathways.
• Butterbur Extract: Some studies suggest butterbur may be effective as a migraine preventive, though safety concerns around certain preparations exist.

17. Myofascial Pain Syndrome

Description:
Myofascial Pain Syndrome (MPS) is a chronic pain condition involving trigger points—sensitive areas in the muscles that cause referred pain. This syndrome can affect the muscles of the face, neck, and shoulders, leading to facial pain.

Key Symptoms:

• Pain and stiffness in the muscles of the jaw, neck, or shoulders.
• Trigger points that, when pressed, cause referred pain in the face or other areas.
• Pain that is often dull or aching but can become severe with muscle tension.

Conventional Treatments:

• Trigger point injections with a local anaesthetic or corticosteroid to relieve pain and relax muscles.
• Physical therapy focusing on stretching, strengthening, and posture correction.
• Dry needling, similar to acupuncture, to target specific trigger points.

Alternative Therapies:

• Massage Therapy: Deep tissue massage or myofascial release techniques may help relax tight muscles and reduce pain.
• Yoga and Stretching: Regular stretching and yoga can improve muscle flexibility and reduce muscle tension, potentially preventing pain flare-ups.
• Herbal Supplements: Anti-inflammatory herbs such as turmeric and ginger may provide relief from muscle pain and inflammation.

18. Nummular Headache

Description:
Nummular headaches are rare, characterised by a small, coin-shaped area of pain on the scalp. The pain is usually constant, and there are no neurological symptoms. The exact cause is unknown, but it is thought to involve superficial nerve damage or irritation.

Key Symptoms:

• Localised pain in a circular or oval area on the scalp, often described as a burning or pressure sensation.
• Pain is constant and does not radiate beyond the defined area.

Conventional Treatments:

• NSAIDs for pain relief and inflammation reduction.
• Topical lidocaine patches for localised pain management.
• Tricyclic antidepressants or gabapentin for chronic cases.

Alternative Therapies:

• Capsaicin Cream: Capsaicin may help reduce nerve pain in the scalp, though its efficacy in nummular headache is not well studied.
• Acupuncture: Acupuncture may help alleviate nerve-related pain and improve blood flow to the affected area.
• Biofeedback Therapy: Biofeedback may help patients control physiological responses to pain, reducing the severity of headaches.

19. Occipital Neuralgia

Description:
Occipital Neuralgia involves sharp, stabbing pain at the back of the head, typically due to irritation or injury to the occipital nerves. The pain often radiates from the neck to the scalp and can be triggered by head movement.

Key Symptoms:

• Sudden, severe pain starting at the base of the skull and radiating to the forehead, often described as electric-like shocks.
• Sensitivity of the scalp and pain with neck movement.
• Tenderness in the occipital region.

Conventional Treatments:

• Occipital nerve blocks with local anaesthetic or corticosteroids for immediate pain relief.
• NSAIDs or muscle relaxants to manage pain and reduce muscle tension.
• Physical therapy to address postural issues and reduce nerve compression.

Alternative Therapies:

• Chiropractic Care: Spinal adjustments may help reduce nerve compression and alleviate pain.
• Acupuncture: Acupuncture has been shown to reduce nerve-related pain in some cases, including occipital neuralgia.
• Massage Therapy: Deep tissue massage can help relieve muscle tension in the neck and upper back, potentially alleviating nerve irritation.

20. Oral Cancer

Description:
Oral cancer encompasses cancers that develop in the mouth, including the lips, tongue, gums, and throat. It can be life-threatening if not diagnosed and treated early, with significant risk factors including smoking, alcohol consumption, and HPV infection.

Key Symptoms:

• Persistent sores or ulcers in the mouth that do not heal.
• Lumps or thickened areas in the mouth or throat.
• Difficulty swallowing, speaking, or moving the jaw.
• Unexplained bleeding, pain, or numbness in the mouth.

Conventional Treatments:

• Surgery to remove the tumour and affected tissue.
• Radiation therapy or chemotherapy for advanced cases or to target cancer that has spread.
• Immunotherapy as an emerging treatment for certain types of oral cancer, particularly in cases where other treatments have failed.

Alternative Therapies:

• Nutritional Support: A diet rich in antioxidants and vitamins (including vitamin D, selenium, and zinc) can support the immune system during cancer treatment. Always consult a doctor before using supplements.
• Acupuncture: Acupuncture may help alleviate pain, nausea, and other side effects of cancer treatment.
• Mind-Body Techniques: Practices like yoga, meditation, and guided imagery may help reduce stress and improve quality of life during treatment.

21. Osteomyelitis of the Jaw

Description:
Osteomyelitis of the jaw is a serious bone infection, typically caused by bacteria entering the bone from untreated dental infections or trauma. It can lead to severe pain, swelling, and destruction of the jawbone if not treated promptly.

Key Symptoms:

• Severe pain in the jaw, often radiating to other areas of the face.
• Swelling, redness, and warmth over the affected area.
• Pus drainage from an abscess or the gums.
• Fever and general malaise in more advanced cases.

Conventional Treatments:

• Antibiotics to treat the bacterial infection, often administered intravenously in severe cases.
• Surgical debridement to remove infected or necrotic bone and tissue.
• Hyperbaric oxygen therapy may be used to accelerate bone healing and enhance the effectiveness of antibiotics.

Alternative Therapies:

• Probiotics: Probiotic supplementation may help restore gut bacteria balance and support the immune system during long-term antibiotic therapy.
• Herbal Antimicrobials: Herbs like goldenseal and echinacea are sometimes used for their natural antibacterial properties, though they should complement conventional treatment.
• Hyperbaric Oxygen Therapy (HBOT): Used in conjunction with antibiotics to enhance healing, particularly in chronic or refractory cases.

22. Parotitis

Description:
Parotitis is the inflammation of the parotid glands, the largest salivary glands located near the ears. It can be caused by bacterial or viral infections, most commonly mumps, or by blockage of the salivary ducts.

Key Symptoms:

• Pain and swelling in the parotid glands, often worse with eating.
• Dry mouth, difficulty swallowing.
• Fever and general malaise in cases of bacterial infection.
• Pus may be present in bacterial infections and can drain into the mouth.

Conventional Treatments:

• Antibiotics for bacterial infections (e.g., staphylococcus).
• Warm compresses and gentle massage of the gland to stimulate saliva flow.
• Surgical drainage may be necessary in cases of abscess or blockage.

Alternative Therapies:

• Hydration and Sialogogues: Encouraging saliva flow by sucking on sour candies or lemon wedges.
• Acupuncture: Some patients find relief from swelling and pain through acupuncture, although this remains an adjunctive therapy.
• Herbal Supplements: Herbs like echinacea and goldenseal may provide some relief from infection, although evidence is anecdotal.

23. Paroxysmal Hemicrania

Description:
Paroxysmal Hemicrania is a rare headache disorder that causes frequent, short, severe headache attacks on one side of the head, typically around the eye. It is similar to cluster headaches but shorter in duration and responds completely to indomethacin.

Key Symptoms:

• Severe, sharp pain around the eye or temple.
• Attacks last between 2 to 30 minutes, occurring several times a day.
• Autonomic symptoms like tearing, nasal congestion, or redness of the eye.

Conventional Treatments:

• Indomethacin is the treatment of choice and provides complete relief for most patients. Long-term treatment may be necessary.

Alternative Therapies:

• Magnesium Supplements: Magnesium can help prevent headaches, though its role in paroxysmal hemicrania is not fully established.
• Acupuncture: Used to stimulate nerve pathways and potentially reduce the intensity of headache attacks.
• Stress Management Techniques: Stress can trigger headache episodes, so techniques like yoga, meditation, and mindfulness may help reduce attack frequency.

24. Peripheral Neuropathy

Description:
Peripheral Neuropathy refers to damage to the peripheral nerves, which can cause pain, numbness, tingling, or weakness. While typically associated with diabetes, infections, or other systemic conditions, it can also affect the face when cranial nerves are involved.

Key Symptoms:

• Numbness, tingling, or burning sensations in the affected areas.
• Muscle weakness, loss of coordination, or balance issues.
• Facial involvement may cause pain, numbness, or tingling in the cheeks, jaw, or forehead.

Conventional Treatments:

• Anticonvulsants (e.g., gabapentin or pregabalin) to manage neuropathic pain.
• Topical treatments (e.g., lidocaine patches or capsaicin cream) for localised relief.
• Physical therapy to help maintain muscle strength and improve coordination.

Alternative Therapies:

• Alpha-Lipoic Acid (ALA): An antioxidant that may reduce neuropathy symptoms, particularly in diabetic patients.
• Acupuncture: Often used to manage nerve pain by stimulating nerve regeneration.
• Herbal Remedies: Some patients use evening primrose oil or St. John’s Wort to alleviate nerve pain, though the evidence varies in effectiveness.

25. Postherpetic Neuralgia

Description:
Postherpetic Neuralgia is a chronic pain condition that occurs after a shingles outbreak, particularly in older adults. It results from nerve damage caused by the varicella-zoster virus, leading to ongoing pain long after the rash has healed.

Key Symptoms:

• Persistent, burning or stabbing pain in the area where the shingles rash occurred.
• Increased sensitivity to touch (allodynia), with even light contact causing significant pain.
• Numbness or tingling may also be present in the affected area.

Conventional Treatments:

• Anticonvulsants (e.g., gabapentin or pregabalin) for neuropathic pain.
• Topical treatments (e.g., lidocaine patches or capsaicin cream) for localised relief.
• Tricyclic antidepressants (e.g., amitriptyline) to help with chronic pain management.

Alternative Therapies:

• Capsaicin Cream: Capsaicin helps desensitise nerves and may reduce pain associated with postherpetic neuralgia.
• Vitamin B12 Supplements: Vitamin B12 can support nerve regeneration and help reduce symptoms of neuropathy.
• Acupuncture: Acupuncture can provide relief from chronic nerve pain, promoting circulation and reducing tension in affected areas.

26. Raeder’s Syndrome

Description:
Raeder’s Syndrome, also known as Raeder’s paratrigeminal neuralgia, is a rare condition involving severe facial pain and autonomic symptoms, such as Horner’s syndrome (ptosis, miosis, and anhidrosis). It is often associated with vascular abnormalities or tumours.

Key Symptoms:

• Unilateral facial pain, typically near the eye or temple.
• Symptoms of Horner’s syndrome on the same side (drooping eyelid, small pupil, lack of sweating).
• The pain is usually constant and deep, unlike the intermittent shocks of trigeminal neuralgia.

Conventional Treatments:

• NSAIDs or steroid medications for inflammation and pain relief.
• Nerve blocks to provide long-term pain relief.
• Surgical decompression may be needed if a vascular or structural abnormality is causing the symptoms.

Alternative Therapies:

• Capsaicin Cream: May reduce nerve pain by desensitising the affected area.
• Biofeedback: Helps patients manage stress and prevent exacerbations of pain through relaxation techniques.
• Acupuncture: Can help relieve nerve pain and promote relaxation of tense facial muscles.

27. Ramsay Hunt Syndrome

Description:
Ramsay Hunt Syndrome occurs when the varicella-zoster virus reactivates in the facial nerve, causing a shingles outbreak near the ear, facial paralysis, and sometimes hearing loss. It is similar to Bell’s Palsy but includes a distinctive painful rash and additional complications.

Key Symptoms:

• Painful, blistering rash on the outer ear, in the ear canal, or on the tongue.
• Facial paralysis or weakness on the affected side.
• Hearing loss or tinnitus (ringing in the ears).
• Dizziness or loss of balance (vertigo) in some cases.

Conventional Treatments:

• Antiviral medications (e.g., acyclovir or valacyclovir) to shorten the course of the disease and reduce complications.
• Corticosteroids (e.g., prednisone) to reduce inflammation and improve recovery of nerve function.
• Pain management for nerve pain, often with anticonvulsants (gabapentin or pregabalin) or opioids in severe cases.

Alternative Therapies:

• Physical therapy: Facial exercises can help improve muscle strength and coordination during recovery.
• Acupuncture: May help stimulate nerve function and reduce pain.
• Vitamin B12: As nerve damage is involved, B12 supplementation may support nerve regeneration.

28. Short-lasting Unilateral Neuralgiform Headache Attacks with Conjunctival Injection and Tearing (SUNCT)

Description:
SUNCT is a rare headache disorder characterised by short, sharp attacks of facial pain, usually centred around the eye, along with redness (conjunctival injection) and tearing. Attacks are frequent and brief, occurring multiple times a day.

Key Symptoms:

• Severe, stabbing pain around the eye or temple.
• Redness and tearing in the affected eye.
• Attacks last from 5 to 120 seconds, occurring up to 200 times a day.

Conventional Treatments:

• Lamotrigine is often used to reduce the frequency and severity of attacks.
• Topiramate and gabapentin are also used to manage symptoms.
• Intravenous lidocaine during acute periods can provide temporary relief from frequent attacks.

Alternative Therapies:

• Magnesium Supplements: Low levels of magnesium have been linked to headache disorders, and supplementation may help in some cases.
• Acupuncture: Some patients report that acupuncture helps reduce the frequency of headache episodes.
• Stress Management: Relaxation techniques, such as mindfulness or meditation, may help reduce the frequency and intensity of attacks.

 

29. Short-lasting Unilateral Neuralgiform Headache Attacks with Autonomic Symptoms (SUNA)

Description:
SUNA is a rare headache disorder similar to SUNCT, but it lacks conjunctival injection (eye redness). It involves short, sharp headache attacks accompanied by tearing and nasal congestion. SUNA is part of the trigeminal autonomic cephalalgias.

Key Symptoms:

• Sudden, intense pain around the eye or temple.
• Tearing and nasal congestion on the affected side.
• Attacks last seconds to minutes and occur frequently throughout the day.

Conventional Treatments:

• Anticonvulsants like lamotrigine or gabapentin are commonly used to manage symptoms.
• Nerve blocks can provide temporary relief for patients with severe or refractory symptoms.

Alternative Therapies:

• Capsaicin Nasal Spray: Capsaicin can desensitise the nerves, potentially reducing the frequency of attacks.
• Stress Reduction: Mindfulness practices and meditation can help reduce stress, which may lower the frequency and severity of attacks.
• Acupuncture: Although not a primary treatment, some patients report relief from SUNA symptoms with acupuncture.

30. Sarcoidosis

Description:
Sarcoidosis is an inflammatory disease that can affect multiple organs, including the lungs, skin, and facial nerves. When the facial nerves are involved, it can cause facial pain, swelling, and even paralysis similar to Bell’s Palsy.

Key Symptoms:

• Granulomas (small areas of inflammation) in affected organs, including the lungs, skin, and facial nerves.
• Facial pain, numbness, or paralysis.
• Shortness of breath if the lungs are affected.

Conventional Treatments:

• Corticosteroids (e.g., prednisolone) to reduce inflammation.
• Immunosuppressive drugs like methotrexate or azathioprine in more severe or chronic cases.
• Hydroxychloroquine for skin involvement.

Alternative Therapies:

• Anti-inflammatory Diet: A diet rich in anti-inflammatory foods like omega-3 fatty acids, antioxidants, and whole foods may help reduce systemic inflammation.
• Vitamin D and calcium supplements: Since sarcoidosis can affect calcium metabolism, these supplements may be necessary, but they should be managed carefully under medical supervision.
• Acupuncture: Acupuncture may help reduce inflammation and improve overall well-being in patients with chronic inflammatory diseases.

31. Sialolithiasis (Salivary Gland Stones)

Description:
Sialolithiasis refers to the formation of stones in the salivary glands, blocking the flow of saliva and leading to pain, swelling, and sometimes infection. The submandibular gland is most commonly affected.

Key Symptoms:

• Pain and swelling in the affected salivary gland, especially during eating.
• Dry mouth or difficulty swallowing.
• If infection occurs, pus may drain from the gland into the mouth.

Conventional Treatments:

• Manual massage of the gland to try to express smaller stones.
• Sialogogues (sour foods like lemon drops) to stimulate saliva flow and encourage stone passage.
• Surgical removal of the stone if it does not pass on its own or causes recurrent infections.

Alternative Therapies:

• Warm Compresses: Applying heat to the affected area may help reduce swelling and stimulate saliva flow.
• Hydration: Drinking plenty of water can help increase saliva production and may assist in flushing out smaller stones.
• Acupuncture: Some patients report relief from pain and swelling through acupuncture, although evidence is limited.

32. Sinusitis

Description:
Sinusitis is the inflammation of the sinuses, often caused by infections (viral, bacterial, or fungal), allergies, or structural problems like nasal polyps. It can cause facial pain and pressure, particularly around the forehead, eyes, and cheeks.

Key Symptoms:

• Facial pain or pressure, often around the forehead, eyes, or cheeks.
• Nasal congestion and discharge, which may be yellow or green if bacterial.
• Reduced sense of smell or taste.

Conventional Treatments:

• Decongestants and nasal corticosteroids to reduce swelling and improve sinus drainage.
• Antibiotics for bacterial infections.
• Sinus surgery to improve drainage or remove obstructions in chronic cases.

Alternative Therapies:

• Saline Nasal Irrigation: Using a saline rinse can help clear the sinuses and reduce inflammation.
• Steam Inhalation: Inhaling steam can help moisturise the nasal passages and promote mucus drainage.
• Herbal Remedies: Herbs like goldenseal, echinacea, and elderberry are sometimes used for their anti-inflammatory and antimicrobial properties.

33. Sluder’s Neuralgia (Sphenopalatine Neuralgia)

Description:
Sluder’s Neuralgia, also known as sphenopalatine neuralgia, is a rare condition that causes severe facial pain, typically originating from the area behind the nose (sphenopalatine ganglion). The pain often radiates to the eyes, upper jaw, and forehead, mimicking other headache disorders.

Key Symptoms:

• Deep, constant facial pain, often described as burning or stabbing.
• Pain radiates to the eyes, nose, or upper jaw.
• Associated with nasal congestion, tearing, or other autonomic symptoms.

Conventional Treatments:

• Nerve block injections in the sphenopalatine ganglion can provide long-term pain relief.
• NSAIDs or anticonvulsants for managing pain.
• Surgical decompression may be considered for patients with structural abnormalities contributing to the condition.

Alternative Therapies:

• Acupuncture: Acupuncture can stimulate blood flow and alleviate nerve pain in the face.
• Biofeedback Therapy: Learning techniques to control stress and physiological responses may help manage the pain associated with neuralgia.
• Capsaicin Cream: Some patients use capsaicin to desensitise the nerves and reduce pain, though its effectiveness for Sluder’s Neuralgia is not well-documented.

34. Temporomandibular Joint (TMJ) Disorder

Description:
TMJ disorders are conditions affecting the jaw joint and surrounding muscles, leading to pain, stiffness, and difficulty moving the jaw. TMJ disorders are often caused by arthritis, injury, or bruxism (teeth grinding).

Key Symptoms:

• Pain in the jaw joint, face, or neck, often aggravated by jaw movement.
• Clicking or popping sounds when opening or closing the mouth.
• Difficulty chewing or opening the mouth fully.

Conventional Treatments:

• Mouthguards to prevent teeth grinding (bruxism).
• NSAIDs for pain relief and inflammation.
• Physical therapy to improve jaw mobility and reduce muscle tension.

Alternative Therapies:

• Acupuncture: Acupuncture may reduce TMJ pain by targeting pressure points and relieving muscle tension.
• Chiropractic Care: Realigning the neck and jaw may help alleviate TMJ-related symptoms.
• Botox Injections: Botox can relax the jaw muscles, reducing pain caused by muscle overuse in bruxism.

35. Tension-Type Headache

Description:
Tension-type headaches are the most common type of headache, characterised by mild to moderate pain that feels like a tight band around the head. They are often triggered by stress, muscle tension, or poor posture.

Key Symptoms:

• Dull, aching pain around the forehead, temples, or back of the head.
• Sensation of tightness or pressure, often described as a “headband” sensation.
• Pain is usually bilateral and does not worsen with physical activity.

Conventional Treatments:

• Over-the-counter pain relievers like ibuprofen or acetaminophen (paracetamol).
• Tricyclic antidepressants (e.g., amitriptyline) for chronic tension-type headaches.
• Physical therapy to address muscle tension and improve posture.

Alternative Therapies:

• Yoga and Stretching: Regular yoga and stretching exercises can help improve posture, reduce muscle tension, and prevent tension headaches.
• Massage Therapy: Massage of the neck, shoulders, and scalp can relieve muscle tightness that contributes to tension headaches.
• Essential Oils: Peppermint oil and lavender oil applied to the temples or back of the neck may help relieve tension headaches.

36. Tolosa-Hunt Syndrome

Description:
Tolosa-Hunt Syndrome is a rare condition that causes painful ophthalmoplegia (paralysis of the eye muscles) due to inflammation in the cavernous sinus or superior orbital fissure. It results in severe pain around the eye and double vision.

Key Symptoms:

• Intense pain around the eye, typically unilateral.
• Paralysis or weakness of the eye muscles, causing double vision (diplopia).
• Drooping of the upper eyelid (ptosis).

Conventional Treatments:

• Corticosteroids to reduce inflammation and alleviate pain.
• Immunosuppressive therapy may be used in recurrent cases to prevent relapses.

Alternative Therapies:

• Anti-inflammatory Diet: A diet rich in anti-inflammatory foods like omega-3s and antioxidants may help reduce inflammation.
• Acupuncture: Acupuncture may help alleviate eye pain and improve nerve function.
• Stress Management: Stress reduction techniques like meditation may help prevent the recurrence of inflammatory episodes.

37. Trigeminal Neuralgia

Description

Trigeminal Neuralgia (TN) is a chronic pain disorder characterised by sudden, severe, electric shock-like pain along the distribution of the trigeminal nerve (cranial nerve V), which transmits sensations from the face to the brain. The pain is typically triggered by everyday activities like eating, speaking, or light touch, and TN is widely considered one of the most painful conditions, often worsening over time.

Key Symptoms:
•       Intense, stabbing or shock-like pain, usually on one side of the face.
•       Pain can affect the cheek, jaw, teeth, gums, lips, or, in rarer cases, the forehead.
•       Episodes last from a few seconds to two minutes, often occurring in bouts.
•       Common triggers include chewing, brushing teeth, speaking, or even wind or temperature changes.

Causes and Triggers:
•       Vascular Compression: The most frequent cause of TN is compression of the trigeminal nerve by a nearby blood vessel, typically an artery. Over time, this can lead to nerve damage and heightened sensitivity.
•       Multiple Sclerosis (MS): TN can occur as a result of demyelination of the trigeminal nerve due to MS.
•       Tumours or Lesions: In rarer cases, TN may be caused by tumours or lesions pressing on the nerve, though these cases tend to present with additional neurological symptoms.

Differential Diagnosis:

•       Postherpetic Neuralgia: Unlike TN, postherpetic neuralgia occurs after a shingles outbreak and is associated with a persistent burning sensation rather than the brief, sharp pain seen in TN.
•       Atypical Facial Pain: TN is characterised by sudden, shock-like pain, while atypical facial pain is often constant and diffuse, without clear triggers.

Diagnostic Tools:
•       MRI with contrast is used to rule out structural causes such as tumours or multiple sclerosis and to visualise vascular compression of the trigeminal nerve.
•       Trigeminal reflex testing may be performed in uncertain cases to assess nerve function and help in diagnosis.

Conventional Treatments:
•       Anticonvulsants: Carbamazepine is the first-line medication, often effective in reducing nerve pain. Oxcarbazepine is another alternative, with a similar mechanism but fewer side effects.
•       Microvascular Decompression (MVD): This surgical procedure is highly effective for TN, relieving pressure on the trigeminal nerve by repositioning or removing the blood vessel causing compression. MVD has a success rate of 80-90%, with a lower recurrence rate compared to other interventions.
•       Gamma Knife Radiosurgery: This non-invasive treatment targets the trigeminal nerve with precise radiation, useful for patients who are not suitable candidates for MVD or prefer a less invasive approach.
•       Radiofrequency Ablation or Rhizotomy: These procedures involve selectively damaging the trigeminal nerve to block pain transmission, though they can result in facial numbness.

Alternative Therapies:
•       Acupuncture: Although evidence is anecdotal, some patients report relief from acupuncture, which may help reduce overall pain perception in TN.
•       Capsaicin Cream: Topically applied capsaicin, derived from chili peppers, is used to desensitise nerves, though its effectiveness in TN remains limited.
•       Vitamin B12: B12 supplementation may support nerve health, and some studies suggest it could help reduce neuropathic pain, though specific research on TN is sparse.

Prognosis:
Medications often control TN symptoms effectively, though the condition may progress over time, with pain becoming more frequent and severe. Surgical interventions like MVD offer long-term relief, and early treatment typically leads to better outcomes. However, recurrence is possible even after surgery.

Referral Guidance:

•       Referral to a neurologist is critical for diagnosis and to explore medical management options, especially in treatment-resistant cases.
•       Neurosurgical referral is advisable for patients who do not respond to medications and may be candidates for MVD, Gamma Knife Radiosurgery, or other surgical treatments.

 

At Trigeminal Neuralgia Association, the Facial Pain Charity, we are here to support anyone with facial pain. Please look at our website www.tna.org.uk for more information about what we do and how we support our members.