Facial Pain: Causes and What Helps

Facial pain by location

Common causes

Sinusitis

Sinusitis causes pressure or pain in the cheeks, forehead or between the eyes, worse when bending forward, with a blocked nose and thick discharge. Most cases follow a cold and improve within 10 days. Bacterial infection is more likely if symptoms last over 10 days or worsen after improving. A frequent pitfall: many people with recurring "sinus headaches" and no nasal discharge actually have migraine.

Dental problems

A cracked tooth, decay, a dental abscess or an impacted wisdom tooth can cause pain that spreads to the cheek, jaw, ear or temple. Clues are pain triggered by hot, cold or sweet foods, tenderness on biting, gum swelling and a bad taste. Upper molar pain can mimic sinusitis, and sinusitis can make upper teeth ache.

Temporomandibular joint disorders

TMD affects the jaw joint and chewing muscles. Pain is felt in front of the ear, in the cheek and temple, and is worse with chewing, yawning or clenching. Clicking, limited opening and morning jaw ache from night-time grinding are typical. It is most common in women aged 20 to 40.

Migraine and cluster headache

Migraine can be felt mainly in the face, especially around the eye and cheek, with nausea and light sensitivity. Cluster headache causes excruciating pain around one eye lasting 15 to 180 minutes, with a watering eye, runny nostril and restlessness on the same side, often at the same time each day for weeks.

Nerve-related facial pain

Trigeminal neuralgia

Trigeminal neuralgia causes sudden, severe, electric-shock or stabbing pains on one side of the face, usually in the cheek or jaw, lasting a second to 2 minutes. Light touch, washing, shaving, chewing, talking or a breeze can trigger it. It is most often caused by a blood vessel pressing on the trigeminal nerve, and is more common after 50. In younger people, multiple sclerosis is a possible cause.

Shingles and postherpetic neuralgia

Shingles causes burning pain on one side of the face, followed in a few days by a band of blisters. Rash on the tip of the nose suggests the eye is at risk and needs urgent eye assessment. Pain lasting more than 3 months after the rash is postherpetic neuralgia.

Other nerve pains

Glossopharyngeal neuralgia causes stabbing pain in the throat, tongue base and ear when swallowing. Persistent idiopathic facial pain (also called atypical facial pain) is a constant, poorly localized ache without an identifiable cause.

Serious causes not to miss

• Giant cell arteritis: new headache or temple pain, scalp tenderness and jaw pain when chewing in people over 50. It can cause sudden blindness and needs same-day steroids.
• Acute angle-closure glaucoma: severe eye and brow pain with a red eye and blurred vision.
• Heart attack: can present as jaw or lower face pain triggered by exertion.
• Tumors: cancers of the sinuses, nasopharynx or salivary glands can cause persistent one-sided pain with numbness, nosebleeds or a blocked nostril.
• Facial cellulitis and deep infections spreading from teeth or sinuses.

Describing the pain helps diagnosis

How doctors diagnose facial pain

Your doctor or dentist will ask where the pain is, what it feels like, how long each episode lasts, what triggers it, and about nasal, dental, eye and jaw symptoms. They will examine the teeth and gums, sinuses, jaw joint and chewing muscles, eyes, ears and facial sensation.

Tests may include:

• dental X-rays
• CT of the sinuses for chronic or complicated sinusitis
• MRI of the brain for trigeminal neuralgia or numbness
• blood tests (ESR, CRP) for giant cell arteritis, followed by a temporal artery biopsy or ultrasound

Treatment

• Sinusitis: saline rinses, steroid nasal sprays, pain relievers. Antibiotics only for likely bacterial infection.
• Dental causes: fillings, root canal treatment, drainage or extraction, plus antibiotics for spreading infection.
• TMD: soft diet, jaw rest, warm or cold packs, jaw exercises, a night guard, and stress management. Most cases improve within weeks to months without surgery.
• Migraine and cluster headache: specific acute and preventive treatments, including oxygen for cluster attacks.
• Trigeminal neuralgia: carbamazepine is the usual first-line medicine. Microvascular decompression surgery or targeted procedures help when medicines fail.
• Shingles: antiviral medicine started within 72 hours of the rash. The shingles vaccine is recommended for adults 50 and older.

For short-term pain relief, acetaminophen (paracetamol) or ibuprofen can be used, following the label dose. Standard pain relievers do little for trigeminal neuralgia.

Frequently asked questions

What is the most common cause of facial pain?

Dental problems and sinusitis are the most common causes, followed by jaw joint disorders (TMD) and headaches such as migraine. Nerve conditions like trigeminal neuralgia are less common but cause very characteristic pain.

Why does only one side of my face hurt?

One-sided facial pain often comes from a tooth, one sinus, one jaw joint, trigeminal neuralgia, cluster headache or shingles. The type of pain, its triggers and other symptoms help tell them apart. Persistent one-sided pain with numbness should always be checked.

What does nerve pain in the face feel like?

Facial nerve pain such as trigeminal neuralgia feels like sudden electric shocks or stabbing on one side, lasting seconds, often triggered by touching the face, chewing or talking. Shingles-related nerve pain is more burning and constant.

Can stress cause facial pain?

Yes. Stress often leads to clenching and teeth grinding, which strains the jaw muscles and joint and causes aching in the cheeks, jaw and temples. Stress can also trigger migraine and tension headaches that are felt in the face.

When should I see a doctor for face pain?

See a doctor for pain lasting more than a week, pain with fever and swelling, electric-shock pains, a rash, numbness, or jaw pain when chewing if you are over 50. Get emergency care if face pain comes with stroke signs or chest symptoms.