Face pain

Face pain may be dull and throbbing or an intense, stabbing discomfort in one or both sides of the face or forehead.

Pain that starts in the face may be caused by a nerve disorder, an injury, or an infection in a structure of the face. Face pain may also begin elsewhere in the body.

Sometimes face pain occurs for no known reason.

• Abscessed tooth (continuous throbbing pain on one side of the lower face aggravated by eating or touching)
• Cluster headache
• Herpes zoster (shingles) or herpes simplex (cold sores) infection
• Injury to the face
• Migraine
• Myofascial pain syndrome
• Sinusitis or sinus infection (dull pain and tenderness around the eyes and cheekbones that worsens when bending forward)
• Tic douloureux
• Temporomandibular joint dysfunction syndrome

Follow the treatment prescribed for the cause of the pain.

Painkillers may provide temporary relief. If the pain is severe or persistent, call your primary health care provider or dentist.

• Face pain is accompanied by chest, shoulder, neck, or arm pain. This could mean a heart attack. Call your local emergency number (such as 911).
• Pain is throbbing, worse on one side of the face, and aggravated by eating. Call a dentist.
• Pain is persistent, unexplained, or accompanied by other unexplained symptoms. Call your primary health care provider.

In emergency situations (such as a possible heart attack), you will first be stabilized. Then, the health care provider will take a medical history and perform a physical examination. For tooth problems, expect a referral to a dentist or orthodontist.

You may be asked the following questions:

• What part of your face is in pain?
• Is the pain on both sides?
• If the pain is only on one side, which side is it on?
• Is the pain over a sinus (forehead, cheekbones)?
• Did the pain begin suddenly?
• Is face pain occurring repeatedly (is it recurrent)?
• How long have the episodes of face pain lasted (for how many months)?
• How long does each episode of pain last (how many seconds)?
• Is the pain worse when speaking, chewing, or swallowing?
• Does the pain develop when touching a specific part of the face (trigger point)?
• Did face pain occur before the start of a brain or nervous system problem (weakness, speech loss)?
• What other symptoms do you have?

Diagnostic tests that may be performed include:

• Dental x-rays (if a tooth problem is suspected)
• ECG (if heart problems are suspected)
• Tonometry (if glaucoma is suspected)
• X-rays of the sinuses

Neurological tests will be performed if nerve damage is suspected.

Cutrer FM, Moskowitz MA. Headaches and other head pain. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 421.

Siccoli MM, Bassetti CL, Sándor PS. Facial pain: clinical differential diagnosis. The Lancet Neurol. 2006;5:257-267.

Silberstein SD, Young WB. Headache and facial pain. In: Goetz CG, ed. Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 53.