Facial Pain Disorder

Facial pain is generally a common symptom of an injury or headaches. However, it may also be the cause of an underlying serious medical condition like chronic sinusitis. Here’s why your face might be paining.

While experiencing any form of facial pain, you may have different sensations on your face depending on what is causing it. More often than not, it may be due to nerve damage, muscle weakness, or headaches.

Symptoms you may experience are:

Many believe that the protective sheath of the trigeminal nerve deteriorates, sending abnormal messages along the nerve. Like static in a telephone line, these abnormalities disrupt the normal signal of the nerve and cause pain. Several factors can cause the deterioration of this protective sheath: aging, multiple sclerosis, and tumors; but most doctors agree that it is most often caused by an abnormal vein or artery that compresses the nerve.

Some types of facial pain can result from an infected tooth, sinus infections, shingles or postherpetic neuralgia, or previous nerve injury.

Diagnosing trigeminal neuralgia involves a physical exam and a detailed medical history to rule out other causes of facial pain. The health care provider will ask what the pain is like, what seems to set it off and what makes it feel better or worse.

The provider may recommend imaging or laboratory tests to determine if the pain is caused by a tumor or blood vessel abnormality or by undiagnosed multiple sclerosis. Certain advanced MRI techniques may help the doctor see where a blood vessel is pressing against a branch of the trigeminal nerve.

Facial pain treatment usually starts with medications, and some people don’t need any additional treatment.

However, over time, some people with the condition may stop responding to medications, or they may experience unpleasant side effects. For those people, injections or surgery provide other facial pain treatment options.

If your condition is due to another cause, such as multiple sclerosis, your doctor will treat the underlying condition.

To treat Facial pain disorder, your doctor usually will prescribe medications to lessen or block the pain signals sent to your brain.

Surgical options for trigeminal neuralgia include:

Microvascular decompression. This procedure involves relocating or removing blood vessels that are in contact with the trigeminal root to stop the nerve from malfunctioning. During microvascular decompression, your doctor makes an incision behind the ear on the side of your pain. Then, through a small hole in your skull, your surgeon moves any arteries that are in contact with the trigeminal nerve away from the nerve, and places a soft cushion between the nerve and the arteries.

If a vein is compressing the nerve, your surgeon may remove it. Doctors may also cut part of the trigeminal nerve (neurectomy) during this procedure if arteries aren’t pressing on the nerve.

Microvascular decompression can successfully eliminate or reduce pain most of the time, but pain can recur in some people. Microvascular decompression has some risks, including decreased hearing, facial weakness, facial numbness, a stroke or other complications. Most people who have this procedure have no facial numbness afterward.

Brain stereotactic radiosurgery- In this procedure, a surgeon directs a focused dose of radiation to the root of your trigeminal nerve. This procedure uses radiation to damage the trigeminal nerve and reduce or eliminate pain. Relief occurs gradually and may take up to a month.

Brain stereotactic radiosurgery is successful in eliminating pain for the majority of people. If pain recurs, the procedure can be repeated. Facial numbness can be a side effect.

Other procedures may be used to treat trigeminal neuralgia, such as a rhizotomy. In a rhizotomy, your surgeon destroys nerve fibers to reduce pain, and this causes some facial numbness. Types of rhizotomy include:

Glycerol injection. During this procedure, your doctor inserts a needle through your face and into an opening in the base of your skull. Your doctor guides the needle into the trigeminal cistern, a small sac of spinal fluid that surrounds the trigeminal nerve ganglion — where the trigeminal nerve divides into three branches — and part of its root. Then, your doctor will inject a small amount of sterile glycerol, which damages the trigeminal nerve and blocks pain signals.

This procedure often relieves pain. However, some people have a later recurrence of pain, and many experience facial numbness or tingling.

Balloon compression. In balloon compression, your doctor inserts a hollow needle through your face and guides it to a part of your trigeminal nerve that goes through the base of your skull. Then, your doctor threads a thin, flexible tube (catheter) with a balloon on the end through the needle. Your doctor inflates the balloon with enough pressure to damage the trigeminal nerve and block pain signals.

Balloon compression successfully controls pain in most people, at least for a period of time. Most people undergoing this procedure experience at least some transient facial numbness.

Radiofrequency thermal lesioning. This procedure selectively destroys nerve fibers associated with pain. While you’re sedated, your surgeon inserts a hollow needle through your face and guides it to a part of the trigeminal nerve that goes through an opening at the base of your skull.

Once the needle is positioned, your surgeon will briefly wake you from sedation. Your surgeon inserts an electrode through the needle and sends a mild electrical current through the tip of the electrode. You’ll be asked to indicate when and where you feel tingling.

When your neurosurgeon locates the part of the nerve involved in your pain, you’re returned to sedation. Then the electrode is heated until it damages the nerve fibers, creating an area of injury (lesion). If your pain isn’t eliminated, your doctor may create additional lesions.

TIf chronic facial pain persists in young & adults, seek immediate medical attention.