Understanding Facial Pain: Diagnosis and Treatment

Early and effective treatment of unremitting facial pain can help patients avoid severe and debilitating TMD facial pain.

Facial pain can be confusing because it can have many different root causes, and diagnosing the source can be complex. Facial pain can be generated by issues in the face or teeth, problems in the nervous system, or referred pain from other parts of the body. For example, trigeminal neuralgia (TN), a common cause of chronic facial pain on one side of the face, can be mistaken for a dental abscess or migraine.

Facial pain can be sudden or have a slow onset; TMJ facial pain can escalate and become debilitating. By knowing all available resources for treating this condition, dentists do a better job of making referrals to pain specialists. The stratification of facial pain disorders has evolved from “trying” a fitted night guard to a more comprehensive and integrated approach.

Temporary bruxing devices can appropriately be a best defense for tooth grinding and jaw clenching. However, some causes of facial pain are derived from another source. For example, headaches and sports injuries to the facial region can contribute to uncommon conditions or atypical facial pain presentations.

The Current State of Treating Facial Pain

Facial pain treatments are advancing to more individualized treatment. For years, most dentists had one plan of action that was recommended to all or most patients. Formerly, they were trained to one deviation for facial pain treatment. However, just as every person has a unique medical history, customized facial pain treatment plans are crucial for achieving optimal health and recovery.

Minnesota Head & Neck pain specialists treat all types of facial pain, including TMJ and trigeminal neuralgia, using the latest nonsurgical pain-relieving therapies. Once we develop a working diagnosis, we may perform tests to confirm our recommended pain management plan.

Neuropathic and Non-neuropathic Facial Pain

Facial pain is a broad term that has both neuropathic and non-neuropathic types. Neuropathic facial pain stems from nerve or tissue injury, while non-neuropathic pain has other causes. Neuropathic facial pain can feel sharp, burning, electric, stimulating, or startling; it may be intermittent, undulating, or unrelenting. ^[1]

Pain associated with the temporomandibular joint (TMJ) is known as TMJ pain if it’s most concentrated near the joint. It aligns with neuropathic pain if it’s associated with sensory symptoms in the face. TMJ disorders can cause facial pain that may irritate the trigeminal nerve. This nerve sends sensory information from your face to your brain.

How to Relieve TMJ Facial Pain

The most important step you can take is to get help from a certified Orofacial Pain Specialist.

Given that the specialty of orofacial pain (OFP) is relatively new, it is still underrecognized and underused. OFP is a dental specialty that involves diagnosing, managing, and treating pain disorders in the face, head, neck, jaw, and mouth.

With additional evidence-based TMJ treatment and training materials, medical and dental professionals can become more aware of orofacial pain specialists in their area to whom patients can be referred.

Millions of patients suffering from orofacial pain conditions have poor access to care due to the limited number of dental providers who specialize in the field. Insurers may also be unclear about reimbursement and exclude treatment for orofacial pain disorders from their policies. Further education on facial pain will help.

Facial Pain Causes

Facial pain can have many causes, and there are many types of facial pain.

According to the National Institute of Health and Craniofacial Research, “The most common cause of facial pain is a group of conditions called temporomandibular joint and muscle disorders (TMJDs).” The July 2018 Overview and Statistics on Facial Pain article states that “TMJDs are the second most commonly occurring musculoskeletal conditions resulting in pain and disability (after chronic low back pain), affecting approximately 5 to 12% of the population.”

Common causes of facial pain include:

TMJ (temporomandibular joint disorder, affecting a jaw joint).
Trigeminal neuralgia can cause intense facial pain.
An abscessed tooth.
Injury from a sports accident, another injury, or treatment.
Severe sinus infection.
An outbreak from the same virus that causes chickenpox, shingles, and cold sores.
Migraine headache or cluster headache.
Chronic muscle pain syndrome.
Deviated Septum.
Unresolved mental and emotional issues.
Burning mouth syndrome.
Mouth Cancer.^[2]

Why Does My Face Hurt?

Your head and neck region have a complex anatomy. Its system of nerves is famous for referred pain, which can add to diagnostic challenges that call for an Orofacial Pain Specialist.

Your provider will assess presenting evidence of which nerves or muscles are active and impacted. A treatment plan is best established once we better understand your facial nerve pain.

Someone not coming from a medical background, may simply ask “Why does my face hurt?” To determine a possible cause, your treating physician will start by asking you questions. Like you, we want to know the reason. Since facial pain can stem from many causes, you can prepare for your initial diagnostic appointment by thinking through your answers to questions like these.

Questions that assist an accurate diagnosis:

What brings you in today?
When did your pain start? (Days, weeks, or months ago)
Has the intensity or type of pain changed?
Is it a constant background pain?
Do you notice a particular event that triggers your pain?
Where on your face does it hurt the most?
Do you have any constant facial numbness?
Does touching parts of your face trigger pain?
How severe is your face pain?

Can Face Pain be Psychological?

The psychological aspects of chronic pain conditions represent a significant component of people’s pain experience, and orofacial pain conditions are not an exception.

In the beginning stages of pain (within the first six months), your brain is focused on understanding where the pain is and how long it lasts. This allows you to describe the pain in detail, using words that pinpoint its location and intensity.

However, as time goes on, your brain starts to shift its focus. Instead of just identifying the pain, it becomes more concerned with the emotional and psychological impact of the pain. This means you might begin to describe your pain differently, using words that express how the pain makes you feel rather than where it is located.

Diagnosing Facial Pain

You may have seen other doctors or been put through many tests and dental procedures before learning that an Orofacial Pain Specialist is available. We’re committed to finding relief for your pain as quickly as possible. After obtaining an accurate diagnosis, a specialized TMJ pain management team can facilitate successful treatment that fits your needs. The right help avoids unnecessary procedures.

The face has many nerves, muscles, bones, teeth, tissues, and joints connecting in a tight space. That can make pinpointing a cause difficult. At odd times, no cause can be found. An orofacial pain specialist will assess all symptoms to gain an accurate understanding of what is occurring.

Facial Pain Treatment

A precise diagnosis is essential for effective treatment, since facial pain treatments can vary depending on the cause of the pain. Temporary use of an oral appliance may be recommended.

Atypical facial pain is more challenging to diagnose and treat without specialized training. Treatments may include medication, psychotherapy, trigger point injections, biofeedback, meditation, or yoga.

Our clinic’s pain specialists continuously seek to understand how facial nerves process pain signals to provide safe and effective non-surgical pain interventions. One source of information is the National Institute of Dental and Craniofacial Research (NIDCR), which released a new study in April 2022.

“From a throbbing tooth or aching jaw to a pounding migraine, pain in the oral and facial region—known as orofacial pain — afflicts 5% to 12% of the population. Such pain can hinder daily activities like eating, tooth-brushing, and mask-wearing, yet opioid-based pain relievers carry the risk of misuse.

NIDCR researchers recently caught facial nerves on camera responding in real time to pain signals. Their work uncovered a key role for a protein called cyclin-dependent kinase 5 (Cdk5) in pain signaling.

“Essentially, the intensity of the imaging signals correlates with pain signaling at the molecular level. This research really takes our science to the next step — we’re imaging and quantifying pain signals in real time.” – Facial Pain Comes to Light, National Institute of Dental and Craniofacial Research

CONCLUSION: Minnesota Facial Pain Experts

We are specialized multidisciplinary clinics that serve as a regional referral center for adult patients with facial pain disorders, TMD, and Trigeminal Neuralgia.

Schedule your Facial Pain Consultation to gain professional help to stop clenching your jaw. Call (763) 577-2484, (651) 332-7474 or (952) 892-6222 or Schedule A Clinic Visit

Resources:

[1] Facial Pain Association, “What Is Facial Pain?,” Feb 2022, https://www.facepain.org/understanding-facial-pain/what-is-facial-pain/

[2] Linda J. Vorvick, et al., “Face Pain,” July 2023, https://www.mountsinai.org/health-library/symptoms/face-pain
Digre KB. “Headaches and other head pain,” 2024:chap 367, https://booksite.elsevier.com/samplechapters/9781437716047/Sample%20Chapters%20and%20Table%20of%20Contents.pdf
Hadia Anita, et al., “The Association Between Orofacial Pain and Depression,” Feb 2024, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10910975/
OHSU Brain Institute, “Understanding Facial Pain,” current, https://www.ohsu.edu/brain-institute/understanding-facial-pain