Facial Pain

  • As the causes of facial palsy vary, so do the symptoms, and each person’s experience may be slightly different.
  • Typically, the facial nerve does not have pain sensors, and therefore pain from damage to the facial nerve is not usually a symptom.
  • In some conditions, such as Ramsay Hunt syndrome, pain may be one of the most distressing symptoms. In these rare cases, especially in people over 65 years of age, the pain is chronic and may be accompanied by extreme tenderness.
  • People diagnosed with Bell’s palsy may, in the early days, experience pain in or around the ear.
  • For those who have prolonged recovery from Bell’s palsy, pain may be due to the facial muscles being stiff or tight, and help from a physiotherapist or speech and language therapist who specialises in facial palsy may be beneficial.

What causes facial pain?

Facial pain can be caused by the following:

  • Trigeminal neuralgia: trigeminal is the name of the nerve which supplies sensation to the face, mouth, gums and teeth. It has three branches, or divisions. The first branch supplies the forehead, the second the cheek, and the third the jaw. Neuralgia means ‘nerve pain’. Trigeminal neuralgia most commonly occurs as a separate diagnosis completely unrelated to facial palsy. In the majority of cases the cause is unknown, but for those with a single diagnosis of trigeminal neuralgia will experience sudden and intermittent attacks of pain on one side of their face, or in their mouth and teeth. Pain can be mild or severe, and tends to come in bursts of a few seconds or minutes.
  • Postherpetic neuralgia: This is a form of chronic facial pain that follows an attack of shingles (herpes zoster), as in Ramsay Hunt syndrome. The pain is usually of a burning, aching or throbbing nature. Light touch such as clothes against the skin can be extremely painful but firm pressure does not generally cause pain. The effects of treatment are much better when given early. Ordinary painkillers may not be beneficial and may delay you seeking prompt medical treatment.
  • Temporomandibular joint dysfunction: The temporomandibular joint is the joint that hinges your jaw and allows you to open and close your mouth, chew, and speak. In some cases the joint itself is causing a problem, or alternatively it can be the jaw muscles that cause the pain. The pain is normally a dull ache that affects the jaw and muscles in the side of the face near the ear. It may also cause clicking of the jaw or difficulty opening the mouth because of spasm. The pain may extend over the side of the head, and down into the neck. You may need to be referred to a specialist dentist for a careful assessment.

What is the treatment?

Treatment will depend on the cause so you should see your GP. Your GP will take a history and decide whether you require a referral to a specialist dentist or doctor. You may be prescribed specific painkillers specially designed to treat nerve pain.

Studies show that botulinum toxin injections[1] can help with residual facial pain, spasms and involuntary facial movements caused by facial palsy.

[1] https://www.ncbi.nlm.nih.gov/pubmed/28688864

Last reviewed: 25-02-2018    ||    Next review due: 25-02-2021