FACE AND HEAD PAIN

Face and head pain is far more common than most people think. It affects about 90% of adults at some point in their life.

Migraine is one of the most common neurological disorders, as well as one of the most debilitating conditions in the world.

Face pain and head pain cause significant disability and sick days from work. They affect men and women, young or old, and can be mild or debilitating. They can start suddenly or slowly. Head pain can be felt in a small area of the head like on the back of the head or it can be felt over a wide area of the head or face. It can last days or years, and is sometimes hard to treat.

Face and head pain is often short term or acute, and lasts a few days to a few weeks. It usually improves on its own with self-care. It is called subacute face and head pain if it lasts between 4 and 12 weeks.

Chronic face and head pain on the other hand, lasts for 12 weeks or longer, even after the initial injury or underlying cause of pain has been treated. Chronic face and head pain can occur in people that get acute face and head pain. Chronic face and head pain can be difficult to treat.

FACE AND HEAD PAIN SYMPTOMS

Sometimes face and head pain can occur suddenly or it can occur slowly. It can also occur immediately after an injury or the onset of symptoms can be delayed.

Symptoms may include; a sharp pain, deep ache, throb, or pain radiating to other areas of the face and head. There might be tingling, numbness, pins and needles. In some conditions even brushing the teeth or a light breeze on the skin may trigger the pain. Symptoms can sometimes also be experienced in the neck or even down the arm.

Sometimes face and head pain can signify a serious medical condition like a brain bleed (haemorrage) or infection, like meningitis.

• Musculoskeletal problems like

  • TMJ (tempromandibular joint) disorders. Strain and sprains of muscles, ligaments, and tendons around the TMJ can be debilitating. Sometimes the TMJ joint itself can be the cause of pain.

  • Myofascial pain syndrome. Sometimes muscle pain can be more complex and called a myofascial pain syndrome. This is pain that occurs because of problems with the surrounding muscles, ligaments and tendons of the face and head. Muscles may develop discrete little tight knots (taut bands) that are called myo-fascial trigger points. Trigger points are hyperirritable spots in the covering (fascia) surrounding muscle and can be very painful and quite debilitating. When a trigger point is touched or examined, it can cause exquisite pain in and around the area. The masseter muscle in the jaw and just below the TMJ can cause such problems, and the pain may radiate to other areas of the face and head. Sometimes when muscles in and around the face and head are problematic, they can trap little nearby nerves and this can cause various types of face and head pain.

• Cervical spondylosis (cervical osteoarthritis) is neck arthritis, which is usually an age-related condition that affects the joints, discs and ligaments of the neck. This can also occur high in the neck, around the C1/2 joint or C2/3 joint. Spinal problems in this area can cause face and or head pain.

• Nerve pain. Chronic pain in and around the face and head usually has some form of nerve pain involvement. Nerve pain in the face, neck and head might include:

  • Trigeminal neuralgia – this is common and can be excruciatingly painful. People experience shock-like pain in one side of the face that usually last seconds to minutes. Sometimes the pain can change and episodes can last for weeks or months at a time.

  • Glossopharyngeal neuralgia is an irritation of the ninth cranial nerve causing pain in the back of the throat, tongue and ear. Attacks of these electric shock-like pains can be triggered by swallowing or can occur without warning. This neuralgia can be confused with trigeminal neuralgia.

  • Tooth pain (odontalgia). Pain in the orofacial region is very common and tooth-related pain is the usual cause. Most often this pain is caused by dental disease and as such is effectively treated by dental professionals. However in some circumstances the pain may persist and cannot be explained by dental problems. This pain is called chronic dento-alveolar pain, which is best assessed and managed by pain specialists.

  • Mouth pain, also called burning mouth syndrome, is a burning or scalded sensation that affects the tongue, but can also affect the lips, gums, palate, throat or whole mouth. Other symptoms may be a dry mouth, thirst, taste changes, like a bitter or metallic taste, or even loss of taste. Most of the time this is caused by medical conditions like oral infections that can usually be treated, but in some instances, there is no cause for the pain. In these situations, the best management comes from a pain specialist.

  • Shingles symptoms include a painful rash caused by the varicella-zoster virus (chickenpox). The rash develops into itchy blisters, usually on one side of the body, either on the face, chest, back, abdomen or pelvis. Shingles on the head, scalp, face, or in the eye can be debilitating.

  • Post herpetic neuralgia can sometimes follow shingles. Post herpetic neuralgia affects nerves and skin, and causes a severe burning pain that lasts long after the shingles rash and blisters disappear. This condition is best assessed and managed by a pain specialist.

  • Occipital neuralgia is a condition where the occipital nerves become inflamed or injured. These nerves run from the top of the spinal column up through the scalp. Other nerves in the area are the lesser occipital nerves and the third occipital nerves. Pain is usually felt in the back of the head or the base of the skull.

  • Pain after a stroke is where come forms of nerve pain can be triggered by a stroke. This can also be called post-stroke pain or central neuropathic pain.

  • Other types of neuralgia include supraorbital neuralgia, ocular or optical neuralgia, facial neuralgia, and scalp neuralgia.

• There are two main types of headache – one in which headaches are the medical problem (primary headaches) and another where headaches are caused by a medical condition (secondary headaches).

  • Primary headaches include:

    • Migraine. This is a complex medical condition with many symptoms, but the main one is a painful headache, usually on one side. Other symptoms include feeling sick, vomiting, disturbed vision, and sensitivity to light, sound, and smells.

    • Tension-type headaches (tension headaches) are a very common cause of headaches. The pain usually affects both sides of the head and is described as a band around the head. It can radiate almost anywhere around the head.

    • Cluster headaches are extraordinarily painful, recurrent, headaches usually on one side of the head, typically around the eye. There is often also eye watering, nasal congestion, or swelling around the eye.

    • New persistent daily headaches can mimic chronic migraine and chronic tension-type headache.

  • Secondary headache causes include:

    • Cervicogenic headaches are caused by a disorder of the neck (cervical spine) where the pain radiates to the face and or head.

    • Whiplash is a neck injury caused by a strain, sprain, or tear in the soft tissues (muscles and ligaments). It is usually caused by a sudden and severe neck movement e.g. like what may occur during a car accident or fall.

  • Some secondary headaches may signify serious medical conditions like:

    • Problems with blood vessels like tears (dissection), swellings (aneurysms), clots (thrombus), strokes (CVA), bleeding in the brain (intracranial haemorrhage)

    • Infections like meningitis

    • Tumours

There are many other secondary causes of face and head pain and that’s why it is best to get them assessed by a medical specialist. Read more about headaches. 

• When headaches last for more than 3 months they are called chronic and could be assessed and managed by pain specialists alongside neurologists. Chronic headaches could be:

  • Chronic migraine. If someone experiences headaches more than 15 days per month with a migraine on at least 8 of those days, then they may have chronic migraine.

  • Chronic daily headaches are headaches of almost any type that occur very frequently, at least 15 days per month, over a period of six months or more.

  • Medication overuse headaches (rebound headaches). Sometimes pain medications can themselves be the cause of chronic headaches. These headaches can even occur every day.

• Other chronic face and head pains may include chronic eye pain and chronic ear pain.

• Referred pain is where pain in one part of the body can be felt in another part of the body that is nearby. This occurs when different parts of the body share the same nerves to send signals to the spine and brain.

• Sensitisation

  • Sometimes a problem in the nervous system called sensitisation can occur. This is when the pain, usually a nerve pain seems to be spreading up into the body and or down into the arm, or even into the other side of the body. People with sensitisation can even have sensitive skin in the painful region and even light touch using a brush can be exquisitely painful.

• Post-surgical pain

  • After an operation or surgery pain can sometimes persist even after the tissue has had sufficient time to heal. This can occur in up to 25% of all surgeries and sometimes the persistent face and head pain can be intolerable and debilitating. Post-surgical pain can be caused by almost any type of operation, and can be caused by many things, including nerve injury or scarring, ongoing inflammation or infection, muscle weakness and stiffness. This is a complex pain condition and should be assessed and managed by pain specialist physicians in conjunction with the operating surgeons.

Contact us to find out what's causing your pain.

WHO GETS FACE AND HEAD PAIN?

Anyone can get face and head pain, and it can occur at any age, with the majority of first incidents taking place between 20-40 years of age.

Some people are more likely to develop face and head pain. Here are a few risk factors that might make the development of face and head pain more likely:

• Older age

• Trauma or injury to the face and or head

• Depression and anxiety

WHAT FACE AND HEAD PAIN TREATMENT IS AVAILABLE? 

Treatment of the face and head pain depends on whether the problem is acute (meaning it only occurred recently i.e. days and weeks) or chronic (meaning it has been present for more than 2-3 months).

ACUTE FACE AND HEAD PAIN TREATMENT

• Simple treatments like hot or cold packs, physical activity and exercise and physical therapy.

• Pain medications like anti-inflammatories and anti-spasm medications to provide you pain relief.

• If the pain is caused by dental or mouth problems these are usually treated by your dental professional.

If pain is long lasting (chronic pain), debilitating and has not been responding to treatments, an assessment should be made by a pain management specialist, who can assess and treat most types of chronic pain.

TYPES OF TREATMENT

• Medications to reduce the pain

  • These may be simple over the counter medications or can be pain medications prescribed by your pain specialist. Medications might include muscle relaxants or nerve pain medications (neuropathic pain medications). Sometimes analgesic compound creams are used to ease pain.

• Pain interventions

  • Injection therapies can be used to target, diagnose and manage chronic pain caused by muscle, joint and nerve pain.

  • It includes interventional therapies like nerve blocks around the face and head (sphenopalantine nerve, supraorbital or supra-trochlear nerve, mandibular nerve, auriculotemporal nerve, occipital nerves and even the facial nerve)

  • (medial branch nerve, lumbar nerve roots, cluneal nerves, gluteal nerves, sciatic nerve, lumbar plexus), radiofrequency ablation (RFA), pulsed radiofrequency (PRF) to various structures like the greater occipital nerve, facial nerves, suboccipital space and even spinal nerve injections like C2 ganglion block. Sympathetic nerve blocks like stellate blocks can also be performed.

• Nerve stimulation or neuromodulation techniques

  • Advanced pain reduction strategies may include stimulation of the peripheral nerves around the face and head. Sometimes spinal cord stimulation for severe face and head pain can be considered although the usual nerve targets for stimulation for this pain is peripheral nerve stimulation like occipital nerve stimulation or stimulation of facial nerves like the supraorbital, infraorbital or mandibular nerves.

• Surgery is sometimes required. Generally a neurosurgeon may perform a micro-vascular decompression for some forms of trigeminal neuralgia.

• Rehabilitation

  • Most types of chronic pain treatment should be managed alongside some form of specialist rehabilitation. This usually focuses on the TMJ and surrounding muscles, with tmj exercises. This is when the best results occur.

WARNING SIGNS OF MORE SERIOUS FACE AND HEAD PROBLEMS

In some instances, pain can indicate more serious face and head problems. These problems might include cancers, fractures or infection.

• If there is a swelling in or around the brain, this may cause raised pressure in the area. This may signify a serious medical condition like a tumour or infection.

• Fractures of the skull or spine can be caused by a direct hit, fall or accident but sometimes can occur without trauma, as spontaneous fractures.

• Infections of the face, brain or spine tend to occur if patients have a weakened immune system from any cause or medical condition. The infection might be mild like a sinusitis (inflammation of the nasal spaces) or life threatening like meningitis (inflammation of the meninges, which are the membranes covering the brain and spinal cord). Sometimes infections of the spine can occur if there is an infection elsewhere in the body. People with infections are usually unwell and can have sweats and a fever.

• Problems with blood vessels like tears (dissection), swellings (aneurysms), clots (thrombus), strokes (CVA), bleeding in the brain (intracranial haemorrhage) can cause some forms of face and head pain.

• Nerve compression, called myelopathy, where there is a dangerous compression of the spinal cord in the neck. Myelopathy could cause symptoms that might include, weakness or problems with coordination in the legs or feet. Sometimes there can be associated face and head pain.

• Multiple sclerosis, which is a serious condition of the brain and spinal cord, which interferes with nerve impulses. Common complaint may be face pain or head pain or eye pain.

• Temporal arteritis is a condition in which the temporal arteries, which supply blood to the head and brain, become inflamed or damaged. It is also called giant cell arteritis. There can be multiple symptoms including face and head pain.

Seek urgent and specialist medical advice if you have:

• Sudden, unrelenting, disabling and severe face or head pain

• Recent weight loss

• Recent injury or fall

• Signs of infection are present like fever or feeling unwell in any way

• Numbness or tingling of the face, head and or arm(s)

• Changes in vision, hearing or vertigo

• Weakness in arms and or legs

• Problems with bladder or bowel function

• Pain does not settle by itself after a few days or weeks

WORRYING SIGNS FOR HEADACHES:

• A new or different headache

• Change in existing headaches

• “Thunderclap” headache, which has a quick onset and is strongest within seconds to minutes

• “Worst headache ever”

• Focal neurological signs/symptoms which means there are other associated problems like blurred vision, weakness, memory loss or loss of feeling in parts of the body

• New onset headache in those >50 years old

• Headache associated with systemic symptoms e.g. fever, weight loss, jaw pain