Extreme facial pain

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A year-old woman is referred for neurologic consultation because of electrical shocks of pain in a left V3 distribution. The attacks are very brief, but occur many times a day, triggered by cold, touch, and chewing. In between attacks, she is pain free. Her neurologic examination is normal. This straightforward presentation of trigeminal neuralgia leaves the consulting neurologist wondering what to do with the other 45 minutes of the visit. The current article is vignette-based and deals with patients who may not fit into such a neat category.
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Why Does My Face Hurt?

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Facial pain: Types, causes, when to see a doctor, and self-care

Facial pain is pain felt in any part of the face, including the mouth and eyes. Most causes of facial pain are harmless. However, if you have facial pain that seems to come without any known cause, call your doctor for an evaluation. Facial pain can be due to anything from an infection to nerve damage in the face. Common causes of facial pain include:. People often describe facial pain as cramp-like, stabbing, or achy. Pain from other areas in the body, such as the ears or head, may radiate or spread to your face.
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Possible causes of facial pain

Trigeminal neuralgia is extreme pain and muscle spasms in the face. Attacks of intense, electric shock-like facial pain can occur without warning or be triggered by touching specific areas of the face. Although the exact cause of trigeminal neuralgia is not fully understood, a blood vessel is often found compressing the nerve. Medication, injections, surgery, and radiation may be used to treat the pain. Each treatment offers benefits, but each has limitations.
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The most widely accepted view is that myelin damage results from irritation of the nerve, usually a blood vessel that causes the nerve to be compressed. Facial pain resulting from unintentional injury to the trigeminal system from facial trauma, oral surgery, ear, nose and throat ENT surgery, root injury from posterior fossa or skull base surgery, stroke, etc. This pain is described as dull, burning, or boring and is usually constant because the injured nerve spontaneously sends impulses to the brain. The injured nerve is also hypersensitive to stimulation, so attacks of sharp pain can also be present.
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