(Page 1 of 2) This page provides a broad overview of syndromes and disorders that may produce face or head pain. Local referral links are provided for WPAHS care providers who treat these disorders. World-wide information resources are offered to help you understand how each disorder is diagnosed, managed and treated. Please be aware as you read, that the symptoms of some of these problems may overlap. Determining which problem or problems are affecting a particular patient, is a task for a professionally licensed, highly trained care provider. A special note: if you
are having a sudden experience of pain in your face as you read this article,
then please take a personal inventory of other sensations in your body.
If you also have radiating pain in your upper back, chest, or arms, or
if you are perspiring heavily, then please contact an emergency care
center immediately. This combination of symptoms is sometimes
a sign of heart attack.
To move quickly to information on a named disorder, please select a link from the list below.
An abscessed tooth can be described as "severe throbbing pain that tends originally to be localized in the area of the root of the infected tooth. The abscess itself is a pus-filled sac at the root of a tooth... or beween a tooth and the gum. "To diagnose a dental abscess, your dentist will examine your teeth and usually order x-rays to check for any disease. "The dentist may use ice or an electric tester to check the health of a tooth. An electric tester uses a small amount of electrical current to stimulate the nerve. A normal tooth will feel sensitive to the ice or the electrical stimulation but will feel relief when the dentist removes the ice or current. A tooth with an irritated nerve will feel some sensation even when the dentist removes the ice or current. A dead tooth will not feel any sensation at all." It is important to understand that other
facial pain problems can "mimic" abscess. This is particularly true of
Trigeminal
Neuralgia. If X-rays do not show the presence of an abscess,
or if a first dental procedure has not been successful in relieving pain,
then it may be appropriate to ask your Dentist or other care provider whether
some form of neuralgia might be involved.
Reference:
"Face Pain Syndromes,"
Return
to Table of Contents
by Cindy Fleishman, Face Pain Resources "Painful anesthesia or dysaesthesia, often related to surgical trauma or the trigeminal ganglion, [appearing] most frequently after rhizotomy or thermocoagulation has been performed for treatment of ... trigeminal neuralgia. "Anaesthesia dolorosa may also follow upon trauma to the trigeminal complex, and, rarely, after vascular lesions of the central trigeminal pathways. "...Diagnostic criteria are:
A. Pain or dysaesthesia is limited to the distribution
B. Sensation to pinprick is diminished over the
C. Symptoms follow a lesion of the trigeminal nerve
Reference:
Todd
Troost, M.D.
WPAHS Caregivers:
Wake Forrest University Dr. Peter Jannetta, M.D.Additional Info: Trials and Treatments of Anesthesia Dolorosa by George Wiegel. Atypical Facial Pain (Syndrome) might be called more accurately, "facial pain of unknown origin." This diagnosis is reached by elimination, not by positive identification. ATFP is characterized as "...facial pain, often described as burning, aching or cramping, occurs on one side of the face, often in the region of the trigeminal nerve and can extend into the upper neck or back of the scalp." The term is applied by some care givers to pain that has features or an area of distribution that are not seen in other identifiable disorders. Any apparently nerve-related pain that crosses the midline of the face may fall into this category. Some recent studies suggest that AFTP may be an early development of Trigeminal Neuralgia. People suffering with ATFP also seem to be more vulnerable to clinical depression. This does not mean that the pain is "all in their heads." Rather, for many patients with such pain, treatment for depression can reduce pain levels or make it possible to manage the pain for a better quality of life. WPAHS Caregivers: Dr. Peter Jannetta, M.D.Additional Info: Extensively referenced article by Cindy Fleishman at "Face Pain Resources." "The pain of cluster headache is generally very intense and severe and is often described as having a burning or piercing quality. It may be throbbing or constant. The scalp may be tender, and the arteries often can be felt increasing their pulsation. The pain is so intense that most sufferers cannot sit still and will often pace during an acute attack. Cluster headaches generally reach their full force within five or ten minutes after onset. "There are an estimated one million cluster
headache sufferers in the United States, of whom 10 percent are afflicted
with chronic cluster. These appear to primarily affect men, 90 percent
of the sufferers being male. Although cluster headaches produce
some of the most severe pain that a physician will see, they can go into
long periods of remission. No cause has been determined for this
type of headache, but most can be controlled with adequate treatment.
"
Reference:
National
Headache Foundation
WPAHS Caregivers:
From the Menu, select "The Complete Guide to Headache" Dr. Peter Jannetta, M.D.Return to Table of Contents Eagle's Syndrome involves a pattern of head pain due to an "elongation of the styloid process" -- a bony anomaly in the skull. "Although this elongation is present in about 4% of the population, only a few such individuals have pain..." Head pain can occur in one of two major patterns. "The first occurs almost exclusively in patients who have had tonsillectomy and is characterized by a sensation of a foreign body in the throat, difficulty in swallowing, dull and aching pains in the pharynx, and pain referred to the ear. The pharynx pains may be sharp, but are less severe than the momentary, lancinating pains of glossopharyngeal neuralgia. "The second major pattern is that of headache and pain referable to the distribution of the internal or external carotid artery. This is presumed to be caused by pressure upon the involved artery by a medially or laterally deviated and elongated styloid process. "Where impingement occurs on the internal carotid artery, the symptoms are parietal headaches and head pains throughout the distribution of the ophthalmic artery. If the external carotid artery is involved, the pain is referred to the face below the eye. This diagnosis can be suggested by palpation (physical probing) of the elongated process in the tonsillar fossa. Palpation is said usually to produce symptoms identical with those of which he patient complains. Roentgen studies of the pharynx confirm the diagnosis (Catlin, 1963). Eagle's syndrome refers to patients with elongated styloidic processes and cervical facial pain. The condition was reviewed by Baugh and Stocks (1993). " WPAHS Caregivers:Dr. Peter Jannetta, M.D.Return to Table of Contents This problem may resemble Temporal Mandibular Joint problems. It "involves the stylomandibular ligament, a tiny structure that connects the base of the skull with the mandibular, or lower jaw. If injured, this structure can produce pain in as many as seven [different] regions of the face, head and neck: the temple, the TMJ, the ear, the cheek, the eye; the throat, especially when swallowing, and the lower back teeth and jaw bone. Treatment of Ernest syndrome, which is successful about 80% of the time, consists of injections of local anesthetic and medication (Cortisone or Sarapin), physiotherapy, and at times, the use of an intraoral splint." WPAHS Caregivers:Dr. Jack Wilburger, M.D.Return to Table of Contents "The term fibromyalgia means pain in fibrous and muscular tissues. It is a chronic (long-lasting) condition of pain, stiffness, and usually fatigue. Fibromyalgia is more common than most people realize. As many as 3% to 6% of all people have fibromyalgia. Fibromyalgia, is more common in adults than children, and more women have it than men. "What fibromyalgia is exactly, or what
causes it, is not known. Sometimes fibromyalgia occurs in more than one
member of a family. This suggests that the
"Pain is the primary symptom. The aches, pains, and stiffness in multiple muscles, joints, and soft tissues get worse or better from day to day or week to week. Pain also tends to move from one part of the body to another. It is most common in the neck, chest, arms, legs, hips, and back. Other common symptoms are: fatigue which may be mild or severe, headaches, anxiety, depression, problems with the digestive system, especially difficulty swallowing or recurrent abdominal pain or diarrhea. "Fibromyalgia can be difficult to diagnose. The diagnosis is usually made after ruling out other medical problems that have similar symptoms. Your health care provider will ask about your symptoms and do a physical exam. Several blood tests may be done. The most successful treatment for fibromyalgia appears to be a healthy diet and balanced exercise and rest. " WPAHS Caregivers:Dr. Jack Wilburger, M.D.
As indicated in an Intellihealth introduction to headache, "an estimated 45 million Americans experience chronic headaches. For at least half of these people, the problem is severe and sometimes disabling... Not all headaches require medical attention. Some result from missed meals or occasional muscle tension and are easily remedied. " "But some types of headache are signals of more serious disorders, and call for prompt medical care." Of particular concern is any headache which is sudden and severe, associated with convulsions, confusion, or loss of consciousness. A physician should be seen for such complaints, as well as for headache following a blow to the head, associated with pain in the eye or ear, or associated with fever. Migraine is the most common type of vascular headache. "Migraine headaches are usually characterized by severe pain on one or both sides of the head, an upset stomach, and at times disturbed vision," with greatly increased sensitivity to light. Two primary types of migraine are recognized: "classic and common."
"Common migraine is not preceded by an aura... Some people experience a variety of vague symptoms beforehand, including mental fuzziness, mood changes, fatigue, and unusual retention of fluids. During the headache phase of a common migraine, a person may have diarrhea and increased urination, as well as nausea and vomiting. Common migraine pain can last 3 or 4 days. "Both classic and common migraine can strike as often as several times a week, or as rarely as once every few years. Both types can occur at any time. Some people, however, experience migraines at predictable times - near the days of menstruation or every Saturday morning after a stressful week of work. " Reference: Intellihealth
WPAHS Caregivers:
(select 'headache' from left side menu) Dr. John BrillmanReturn to Table of Contents "Multiple sclerosis (MS) is a progressive disabling illness that affects nerve cells in the brain and spinal cord. Under normal conditions these nerve cells are surrounded by an insulating sheath made of fatty "myelin," which speeds the passage of nerve impulses. In MS, this myelin sheath is inflamed or damaged, disrupting nerve impulses and leaving areas of scarring (sclerosis). The disruption of nerve signals within the brain and spinal cord causes a variety of symptoms that may affect vision, sensation, and body movements. These symptoms usually wax and wane through a series of relapses (episodes when symptoms suddenly get worse) alternating with remissions (periods of recovery, when symptoms improve). For many patients, a long history of MS attacks over several decades leads to slowly progressing disability, but for others the disability is more rapid and severe. In still another subgroup of patients (about 10%), the disease is relatively benign." This disease affects over a million young adults world wide. Although the cause of the disease is not known, a number of useful new treatments are emerging from research on auto-immune disorders. Reference: Intellihealth
When the scarring of MS affects the fifth
cranial nerve, face pain very much like trigeminal neuralgia
can occur. About 3-5% of all TN patients may have MS, a larger proportion
than occurs in the general population.
WPAHS Caregivers:
(From the Site Index - select Disease and Condition Guide - D - Demyelinaing Diseases) Dr. Jack Wilburger, M.D.Return to Table of Contents Reference Note: Many
of the links above were researched by Cindy Fleishman, who is herself a
chronic pain patient and Web educator. Additional information is
available at Face Pain
Resources, the site she created and still co-edits. All links
have been reviewed for presentation at WPAHS. Naturally, we cannot
accept responsibility for the accuracy of information offered by other
sites. See Disclaimers.
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DISCLAIMER:Every effort has been made by the author(s) to provide accurate, up-to-date information. However, the medical knowledge base is dynamic and errors can occur. By using the information contained herein, the viewer willingly assumes all risks in connection with such use. Neither the author nor WPAHS shall be held responsible for errors, omissions in information herein nor liable for any special, consequential, or exemplary damages resulting, in whole or in part, from any viewer(s)' use of or reliance upon, this material. CLINICAL DISCLAIMER:Clinical information is provided for educational purposes and not as a medical or professional service. Person(s) who are not medical professionals should have clinical information reviewed and interpreted or applied only by the appropriate health professional(s). |
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Frequently Asked Questions on Healthcare Face Pain Overview * Trigeminal Neuralgia * Hemifacial Spasm * Meniere's Disease * Vertigo * Tinitis * Hypertension * Torticalis and Spasmodic Torticalis For questions or comments, please contact: aghneuro@wpahs.org * Department of Neurosurgery * Allegheny General Hospital * 320 East North Ave. * Pittsburgh, PA 15212 * (412) 359-6200 * Toll Free: 877-284-2000 © 2000 West Penn Allegheny
Health System
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