Face Pain

WHEN TO SEE YOUR DOCTOR

* You also have pain in your eyes.

* You have a fever, develop a rash on your face or your face feels swollen.

* You also feel pain, tingling or numbness in your hands or feet.

What Your Symptom Is Telling You

Doctors know that pain in the face means that you probably have a problem somewhere else?like your head, jaw, neck or even your teeth. Finding the "where" can sometimes take a little detective work.

The face, head and neck have nerves that communicate together. If a nerve in your neck is pinched or irritated, the hurt can travel up that nerve and cause pain in your face, says Steven Mandel, M.D., clinical professor of neurology at Jefferson Medical College and an attending physician at Thomas Jefferson University Hospital in Philadelphia.

Lots of conditions can cause facial pain. People who get migraines or cluster headaches can get it. Sinus, ear and eye infections can cause it. A toothache can make your face hurt. And arthritis in the neck can cause discomfort in the face. A controversial and hard-to-diagnose jaw condition called temporomandibular joint disorder (also known as TMD) can sometimes cause facial pain, although you're likely to experience other symptoms as well, such as a "clicking" sound in the jaw or headaches.

Sharp facial pain is the major symptom of a condition called tic douloureux, a nerve disorder. In those who have the disease, it can be triggered by cold drafts, drinking cold liquids, washing the face, shaving, chewing or even talking.

"Tic douloureux is an intermittent, shocklike pain," says John Loeser, M.D., director of the Multidisciplinary Pain Center at the University of Washington School of Medicine in Seattle. "The mechanism that produces this pain in the face isn't fully understood," he adds. "But we do know that when the pain occurs, there is absolutely nothing else wrong."

Facial pain is also a rare but possible sign of a stroke, although you're likely to experience other symptoms as well, such as numbness or trouble with your vision.

Symptom Relief

Since facial pain is usually caused by an underlying problem, treating that problem?be it toothache, headache or TMD?will make the facial pain go away. (You'll find solutions for treating toothache on page 548 and headache on page 234; see Jaw Problems on page 284 for help with TMD.)

If you have tic douloureux, here are a few things you should know.

Take medication for control. Doctors have found that the best way to control the pain of tic douloureux is through drug therapy. Anticonvulsants or similar medications, such as carbamazepine, that directly affect the nerves are often prescribed.

Consider surgery when medications fail. A minor operation using a special needle inserted into the nerve through the cheek can stop the pain. The downside is that there is some loss of feeling in the area of the nerve.