by Lisa Pavese, FNP, Paul Lynch, MD, and Tory McJunkin, MD
The trigeminal nerve is the fifth cranial nerve and is responsible for communicating sensory information to the brain. Trigeminal neuralgia is an irritation, or inflammation, of the trigeminal nerve and may be triggered by multiple everyday activities including smiling, eating, or brushing the teeth.
The trigeminal nerve has three branches, affecting three different aspects of the face. One or several of these branches can be the culprit causing pain. Identifying the correct nerve is vital to establishing a treatment plan. Another bundle of nerves responsible for some facial pain conditions is called the sphenopalatine ganglion. The sphenopalatine ganglion sits directly behind the nose and may be implicated in pain that occurs in various aspects of the face, primarily in the front.
Many headaches are caused by irritation of the sphenopalatine ganglia. Neuropathic facial pain may also originate from the occipital nerves in a condition called occipital neuralgia. This type of pain generally originates from the back of the head and can radiate to the face. Atypical facial pain is usually idiopathic, meaning that there is no known cause. Atypical facial pain usually occurs in one side of the face, and symptoms are present for most of the day, every day. The diagnosis of atypical facial pain is generally made after more common causes are excluded.
Facial Pain Treatment
Migraine pain is usually treated by utilizing one or more migraine medications, typically a prophylactic and an abortive medication (please see the section on headaches for more discussion of this). Dental pain is usually treated by removing or treating the offending agent; however, there are some injections that might be helpful as well. TMD pain can be treated by steroid injections directly into the joint, as well as TMD splints, chiropractic treatments, and medications, usually an anti-inflammatory such as ibuprofen.
Neuropathic facial pain can be treated by trigeminal nerve blocks, occipital nerve blocks, and sphenopalatine ganglion blocks. Some medications used for neuropathic facial pain include anti-inflammatories, anticonvulsants (gabapentin, carbamazepine), antidepressants (Cymbalta, Savella, amitriptylline), and occasionally opioids (hydrocodone), and opioid-like medications (tramadol).
Neuropathic facial pain is also commonly treated by neuromodulation, such as a spinal cord stimulator or a peripheral nerve stimulator. A study done by Slavin and Colpan, et al (2006) showed that 73% of patients who underwent peripheral nerve stimulator trials received pain relief of 50% or more. Of the patients who underwent permanent placement of peripheral nerve stimulators, some received relief so significant that they actually went on to have the system removed several years later.
These results indicate that neuromodulation is extremely efficacious in the treatment of facial pain. Utilizing multiple treatment modalities offers the most success in treating this very painful condition. Arizona Pain Specialists is a comprehensive pain management clinic that offers many advanced treatment options for all of your pain concerns. If you suffer from chronic facial pain, please call us today to schedule an appointment.
- Chan-Liao, Mingi. Sphenopalatine Ganglion Block- A Simple But Underutilized Therapy for Pain Control. Retrieved February 15, 2010 from: http://www.pain-manage.org.tw/s-pain/s-pain05.htm
- Krolczyk, Stanley (2010) Persistent Idiopathic Facial Pain: Differential Diagnoses & Workup. Retrieved February 15, 2010 from: http://emedicine.medscape.com/article/1142187-diagnosis
- Slavin, K., Colpan, E. , Munawar, N., et al (2006). Trigeminal and Occipital Peripheral Nerve Stimulation for Craniofacial Pain. Retrieved February 16, 2010 from: http://www.medscape.com/viewarticle/554865