Face pain and headache: causes, diagnosis and treatment

Causes of pain in the face and head

Headaches that radiate to the face can have different origins. In some cases it is primary (migraine, cluster pain, tension headache), in others it is one of the symptoms of diseases of the nervous system, musculoskeletal system, heart and blood vessels. It is important to take into account the exact localization of painful sensations, their nature and intensity, and the conditions of occurrence.

Trigeminal neuralgia

The trigeminal nerve is a paired nerve and represents the fifth pair of cranial nerves. In the temporal region it is divided into 3 main branches: the ophthalmic, maxillary and mandibular nerves. They provide facial skin sensitivity, motor activity of the facial and masticatory muscles. When the trigeminal nerve becomes inflamed or damaged, an acute headache begins, which spreads along the nerve fibers. It is so intense that during the period of exacerbation of trigeminal neuralgia, patients cannot touch their face, eat food, turn or tilt their head.

The cause of neuralgia is inflammation of the nerve or its mechanical damage. There are also several factors that can contribute to the development of acute pain:

viral respiratory diseases, as well as herpes virus infection;
neoplasms in the cerebellopontine region of the brain;
dental diseases, including stomatitis, periodontitis and others;
acute purulent inflammation of the paranasal sinuses (sinusitis);
atherosclerosis is a disease in which arterial blood flow deteriorates and the supply of oxygen to brain tissue decreases;
bruises, injuries in the facial area, which are accompanied by damage to nerve fibers.

Headache with trigeminal neuralgia can spread to any part of the face. It is sharp, throbbing, and can be confused with pain caused by dental problems. In some patients, the disease is chronic and worsens at regular intervals. More often this happens in the winter and in the off-season - inflammatory reactions are caused by a sharp drop in temperature and the effect of a viral infection. During an attack, additional symptoms are also felt: increased lacrimation in response to bright lighting, cold weather and decreased sensitivity of the facial skin, involuntary contractions of the facial and masticatory muscles.

In most cases, treatment of trigeminal neuralgia is carried out with medication. The doctor prescribes antibiotics, antiviral and anti-inflammatory drugs. To make you feel better, you will need painkillers. Some patients require surgery to destroy the trigeminal nerve root or remove pathological formations that exert mechanical pressure on the nerve. Physiotherapy is also useful as treatment and rehabilitation.

Cluster pain

Main article: Cluster headaches

Cluster headaches are the least common type. They are characterized by a very high degree of intensity and do not have an exact cause. An attack consists of a series of pain sensations in the area of the projection of the brain onto the human skull. It is so acute that the person cannot continue to carry out daily tasks during this time, and conventional over-the-counter analgesics are ineffective.

Cluster headaches have several features:

first appears in adulthood, most often from 20 to 30 years;
has no warning symptoms, begins abruptly, at any time of the day;
extends only to one half of the head;
accompanied by deterioration of vision, constriction of the pupil, increased heart rate, redness of the skin;
the period lasts from several days to several months - during this time the patient experiences on average 1-3 headache attacks per day, often at the same time.

Cluster pain is more common in women . There is no hereditary predisposition, since the disease in most cases is found in only one family member. After the end of the exacerbation period, a long-term remission is observed. It can last up to 3 years, during which the pain does not bother the patient. A seasonal course of the disease is also possible if it appears only at certain times of the year.

Migraine

Main article: Chronic migraine

Migraine is one of the types of primary headaches. It is often one-sided and affects only one half of the head. Painful sensations can be of varying degrees of intensity, but most often acute. The exact cause of migraine is unknown. It often develops in response to factors such as changes in weather and atmospheric pressure, stress and emotional tension, intense physical activity, disruption of the daily routine, as well as smoking and frequent alcohol consumption, poor diet, and hormonal changes.

Migraine is a one-sided headache. There are several theories of its origin - doctors explain its appearance by vascular, nervous, and hormonal disorders. Migraine can occur in different ways, but the classic form includes several stages:

The initial stage is prodromal. It begins a few days before a headache attack. During this period, a person’s mood often changes, irritability and fatigue appear, concentration and performance deteriorate. This symptom complex does not occur in all patients, but its appearance accurately indicates the onset of migraine.
Aura (Main article: Migraine with aura) is the period several hours before an acute headache. It is typical for migraine, but also does not necessarily occur. Its cause is considered to be spasmodic contraction of brain vessels and deterioration of its blood supply. The aura is manifested by increased sensitivity to sunlight, the appearance of bright circles and dark spots before the eyes, as well as hearing impairment and severe fatigue.
The immediate attack of headache lasts several hours, but in some patients it may not stop for up to several days. It is acute, one-sided, and intensifies in the presence of external stimuli (bright light, loud sounds). Painful sensations are concentrated in one half of the head and can spread to the face and neck. Symptoms such as lacrimation, nausea and vomiting, and dizziness are also typical.
Resolution stage – lasts 1–2 days. Some patients feel better immediately after the headache ends, but resolution may be slow. Symptoms include weakness, decreased alertness, and increased sensitivity to bright lights and loud noises.

According to statistics, migraines are more common in middle-aged women. To treat it, a set of medications is prescribed that help reduce pain and shorten its duration. If attacks occur frequently and do not stop for 3–5 days or more, hospital treatment may be necessary. The procedures are aimed at preventing complications: dehydration, cerebral edema, seizures, heart attack and stroke.

Somatogenic facial pain

Pain in the face and head can be somatogenic (secondary), that is, associated with diseases of other organs and systems. They are less intense than cluster pain, migraine and facial neuralgia, but also affect performance and can cause complications. Common causes of pain in the face are dental diseases, inflammation of the paranasal sinuses, and ophthalmological problems.

Toothache – often spreads to the scalp, skin, muscles and nerves of the face. It is often associated with inflammatory processes and dental caries. Symptoms such as pain in the jaw joints, pain when chewing, or eating cold or hot food and drinks also occur. To make you feel better, consultation with a dentist, medication, and, if necessary, surgery are recommended.
Joint pain is another type of somatogenic pain. They are often triggered by arthritis or arthrosis of the temporomandibular joint, its deformation or injury. In addition, soreness may be a sign of a malocclusion, tooth loss, or discomfort when wearing dentures.
Inflammation of the paranasal sinuses is a group of dangerous diseases. The sinuses (sinuses) are cavities formed by the bones of the skull. Normally, they are empty, filled with air and necessary for proper breathing. Their inflammation is accompanied by the appearance of aseptic or purulent contents, an increase in body temperature, a sharp deterioration in health and nasal congestion. The most common type of sinusitis is sinusitis. It develops as a result of hypothermia, the proliferation of a viral, bacterial or fungal infection, head injuries and bruises.
Eye diseases also cause headaches. When diagnosing pain, glaucoma may be detected - increased intraocular pressure. This is a dangerous condition that requires immediate treatment. Increased pressure causes compression of blood vessels and nerves, and over time can lead to poor vision and even complete blindness.

If a patient complains of pain in the face and head, a comprehensive examination is prescribed. The scheme will include general diagnostics, as well as consultations with specialized specialists: ophthalmologist, otolaryngologist, dentist and others.

Other reasons

Soreness is a symptom of a number of disorders that do not necessarily indicate dangerous diseases. Headaches can occur periodically in a healthy person, and then go away on their own or after taking painkillers. Doctors identify a number of reasons that can cause deterioration in health:

stress, nervous tension;
sleep disturbances caused by insomnia, moving to regions with a different time zone, irregular schedules, or working at night;
poor nutrition, an abundance of fatty foods, flour products, spices and sweets in the diet;
intense physical activity;
sudden changes in weather, temperature or atmospheric pressure;
hormonal changes.

Doctors recommend calling for a full examination if headaches continue for several days or more. Also dangerous are acute pains that affect performance and are accompanied by additional symptoms: nausea, vomiting, impaired coordination of movement, and memory impairment.

Classification of prosopalgia

Facial pain is classified primarily by mechanism of development. Prosopalgia is distinguished:

vascular
neurogenic
myogenic
psychogenic
symptomatic
atypical
painful ophthalmoplegia

Vascular facial pain

includes:

bundle cephalalgia
paroxysmal hemicrania
Horton's disease
idiopathic sudden cephalalgia (ISH)
SUNCT syndrome.

Neurogenic prosopalgia

includes:

trigeminal neuralgia
neuralgia of the glossopharyngeal nerve
ganglionitis and ganglioneuritis of the nerve ganglia of the facial region.

Symptomatic facial pain

. Depending on the etiology, symptomatic prosopalgia is divided into

ophthalmogenic
odontogenic
otorhinogenic
viscerogenic.

To atypical

include pain that does not fit into the clinical picture of any of the types of prosopalgia specified in the classification. They are often caused by a combination of several pathogenetic mechanisms and have a psychogenic component.

Diagnostic methods

For effective treatment, it is important to determine the exact cause of the headache and facial area. It is impossible to carry out diagnosis on your own, since it requires the use of precise equipment and laboratory tests. The complex may include the following activities:

blood tests - prescribed to determine inflammatory processes, bacterial infections and various diseases of the heart and blood vessels;
X-ray is one of the examination methods for suspected diseases of the teeth and temporomandibular joint;
MRI, CT scan of the brain;
ophthalmological examinations aimed at diagnosing vision and measuring intraocular pressure;
assessment of the condition and conductivity of the vessels of the neck and head - carried out by radiography using a contrast agent.

The Clinical Brain Institute offers headache diagnostic programs. The set of measures is selected individually, based on the results of the inspection. To obtain accurate data, it is important to notify the doctor about all conditions for the occurrence of pain, their nature and intensity, and also undergo the prescribed examinations.

Clinical features

Facial pain of various origins differs in its clinical features regarding the nature, duration, paroxysmalness, and vegetative coloring of the pain syndrome. These distinctive features, as well as accompanying symptoms (if any), enable the neurologist to determine the type of prosopalgia, which is fundamental in the diagnosis and subsequent treatment of facial pain.

The permanent (constant) type of pain syndrome is more typical for myogenic, psychogenic and symptomatic prosopalgia. It may occur with episodes of increasing and decreasing pain. Paroxysmal pain phenomenon with intense painful attacks of variable duration against the background of complete or almost complete absence of pain in the interictal period is typical for neurogenic and vascular prosopalgia. A distinctive feature of the latter is the presence of a pronounced vegetative component - during paroxysm, swelling, lacrimation, hyperemia of the skin area, rhinorrhea, nasal congestion, redness of the conjunctiva, etc. are observed.

Bilateral in nature, as a rule, is symptomatic, myogenic and psychogenic prosopalgia. Moreover, the latter may be distinguished by the asymmetry of the pain phenomenon in the halves of the face. Vascular, neurogenic and atypical facial pain is usually unilateral.

Irradiation of pain is more typical with neurogenic and vascular prosopalgia, but can also be observed with facial pain of symptomatic origin. In addition, symptomatic prosopalgia is often reflexive in nature. The most illustrative example is odontogenic prosopalgia, caused by the occurrence of pain in the Zakharyin-Ged zones: mandibular, nasolabial, maxillary, frontonasal, temporal, sublingual, mental, laryngeal. Each zone is a reflection of the pathology of certain teeth, while toothache may be absent.

Treatment of headaches and facial pain

The treatment regimen for headaches and pain in the face is selected individually. It will include measures to eliminate the underlying disease, as well as to relieve symptoms. Based on the diagnostic results, the doctor may prescribe the following methods:

drug treatment - may include anti-inflammatory and painkillers, antibiotics, drugs to improve cerebral circulation;
physiotherapy – carried out to stimulate blood circulation and innervation in the face and head;
diet for blood vessels - includes simple foods, with a minimum amount of fried foods, animal fats, fast food and spices;
surgical intervention - most often prescribed for mechanical compression of nerves and blood vessels, in the presence of neoplasms and dental diseases, as well as for clearing the contents of the paranasal sinuses.

Doctors at the Clinical Institute of the Brain will select appropriate treatment tactics based on the results of a general examination. For most patients, it is enough to take medications, follow a diet and adjust their daily routine to improve their health. However, for some diseases surgical intervention is indicated.

Treatment for inflammation of the facial nerve

Drug treatment

Treatment of trigeminal neuritis is complex. The disease is first treated with medication - the patient is prescribed drugs that will alleviate the situation. These include painkillers, decongestants, vasodilators and B vitamins. Most often, the recommended medications are tablets, but you can speed up the recovery process by using ointments and gels. Sometimes doctors prescribe intramuscular injections.

In special cases, the recovery process of the facial nerve may be slowed down. Then the patient is prescribed glucocorticosteroids, which improve the metabolic processes of nervous tissue. Various biostimulants and hyaluronidases also contribute to a speedy recovery.

You cannot prescribe medications for yourself. Be sure to see a neurologist or neuropathologist at the first symptoms to determine the diagnosis and treatment strategy. Recovery medications are recommended to patients on a case-by-case basis, paying attention to the presence of chronic diseases, symptoms, and so on.

Surgery

Another way to treat the facial nerve is surgery. However, doctors turn to this option quite rarely - only when the trigeminal nerve is ruptured. Surgery is also required if there is no effect from the conservative method after six months or a year. Surgical intervention is only relevant during the first year of the presence of the disease; later, the muscles on the face irreversibly atrophy.

The surgical process involves suturing the damaged area of the facial nerve to restore its motor function.

Massage

The next treatment method is massage for the treatment of the facial nerve. The purpose of this method is to remove swelling, improve blood circulation, restore sensitivity and conduction of nerve impulses. Massage is contraindicated for tuberculosis, oncology, atherosclerosis and elevated temperature.

Initially, the massage therapist works only with the healthy side of the face, collar area, neck and area above the shoulders. Basically, the master uses rubbing, stroking, kneading and vibration.

For noticeable desired changes, it is necessary to conduct ten to twenty massage sessions from five to fifteen minutes. The duration is determined based on the degree of inflammation of the trigeminal nerve, the goals of therapy and the dynamics of recovery.

Physiotherapy

The next treatment method is physical therapy. It alleviates the severity of symptoms, helps to activate metabolic processes in tissues and restore the functions of the facial nerve.

Doctors prescribe this course of treatment from the first days of the onset of neuritis. The list of physical procedures includes:

Ultrasound
Laser irradiation of blood
Electrophoresis of drugs
Microwave therapy
Exposure to ultra-high frequency electricity
Ozocerite treatment
Myoelectrostimulation
Darsonvalization

This complex is indicated for the first week of treatment. Doctors prescribe it together with medication. This tandem helps speed up the process of restoration of the facial nerve. And its most important advantages are the absence of side effects and painlessness.

Alternative Methods

There are also alternative treatment methods. These are procedures aimed at restoring facial muscles and eliminating the symptoms of facial neuritis. Such procedures include:

Clay or paraffin masks
Acupuncture
Reflexology
Injections to eliminate muscle disorders
Therapeutic baths
Taping – stretching the face using adhesive plasters
Immunosorption – purification of blood from antigens and antibodies
Biofeedback – facial muscle training

Gymnastics for the face

Also, in conjunction with complex treatment, you can do facial exercises. Before this, you need to consult with a specialist; the doctor will draw up an individual list of exercises based on the severity of the process, location of the lesion and symptoms. Typically, such gymnastics takes about ten minutes a day.

A standard set of exercises includes relaxing and tensing individual facial muscles. For example, to restore articulation, it is recommended to pronounce the sounds “u”, “o”, “and”. Afterwards, you need to bring your lower lip under your upper teeth and reproduce the sounds “v” and “a”.

Gymnastics for inflammation of the trigeminal nerve:

Close eyes
Raise your eyebrows
Frown
Squint
Smile with your mouth closed
Smile with your mouth open
Puff up your cheeks
Pull them back
Whistle
Widen your nostrils
Curl your lips
Raise your upper lip and return to the starting position
Lower your lower lip and return to the starting position
Take water into your mouth
Rinse your mouth
Close your mouth
Run the tip of your tongue along your gums
Move your tongue right and left

Prevention methods

Timely prevention is the key to good health at any age. It is important to form the right habits that will have a positive effect on the health of the heart and blood vessels, teeth and other organs. Doctors recommend:

eat right, get enough vitamins and microelements;
give up bad habits - smoking and drinking alcohol affect the condition of blood vessels;
normalize your daily routine and devote enough time to rest;
carry out moderate physical activity to train the heart muscle.

At the Clinical Brain Institute you can undergo an accurate and high-quality diagnosis of headaches and pain in the face. There is modern equipment here that can be used to determine the causes of pain. Doctors will also select an effective treatment regimen for use at home or in the hospital of our center.

Dental problems

Another cause of jaw problems can be pathologies in the oral cavity:

Caries in the middle and deep stages. Without timely treatment, tooth decay exposes the pulp (dental nerve), causing inflammation. This leads to swelling, pain and spasms in the gum tissue.
Mechanical injury. Dislocation, impact, damage to the dentofacial apparatus also provoke spasms of the facial muscles.
Eights. Growing wisdom teeth can cause a lot of trouble for the patient, including problems with the cheekbones.

Regular preventive examinations at the dentist - once every six months - will help eliminate the risk of jaw reduction. It would be a good idea to visit an otolaryngologist in case of inflammation in the ears. And a maxillofacial surgeon if there are jaw injuries.

Important: sudden and unexplained contraction of the cheekbones can signal more serious illnesses. This is one of the signs of a stroke, heart attack or angina. In this case, you must immediately call an ambulance.