You wake up and your temples hurt. Or you have stabbing bouts of pain around your nose. Or your jaw is throbbing. Yours could be one of any number of face pain maladies: an abscessed tooth, a sinus infection or the more formally named trigeminal neuralgia, a sudden shock-like pain caused by a blood vessel pressing on a nerve.
If unexplained face pain is your Waterloo, here are the most common causes and how to deal with each.
Face pain cause: Abscessed tooth
“An abscessed tooth is one infected with bacteria that have spread into surrounding bone and gums,” says Dr. Vanessa Benavent, Clinical Director of the Brotman Orofacial Pain Center at the University of Maryland School of Dentistry. “If untreated, the infection can spread to the face, neck and even the brain.” An infection usually crops up from untreated tooth decay, or a broken or cracked tooth.
How to fix? “Some teeth can be saved with a root canal that cleans out the infected nerve and saves the tooth,” says Benavent. “Sometimes the tooth has to be removed. Getting rid of the infection is the most important step.”
Sinus infection/ Sinusitis
“A sinus infection, or sinusitis, is an acute bacterial or viral infection of the [nasal] sinuses,” says Dr. Robert Merrill, Director of the Orofacial Pain Residency Program and an adjunct professor at the UCLA School of Dentistry. According to a 2011 Centers for Disease Control survey, 29.6 million Americans were diagnosed with sinusitis that year.
How to fix? “If sinusitis lasts less than 10 days, it is usually viral and doesn’t require antibiotics,” says Benavent. “If you feel severely ill, or the sinusitis last more than 10 days, or blooms again, it may be a bacterial infection requiring antibiotics.” However, taking unneeded antibiotics help create antibiotic-resistant bacteria, she adds.
“The joint that holds the lower jaw below the skull is the temporomandibular joint, or TMJ,” says Benavent. Problems with the joint or nearby muscles can cause pain—headaches, neck pain, face pain, painful jaw movements and jaw noises—resulting in temporomandibular joint disorder, she says. According to the National Institute of Dental and Craniofacial Research, 5 to 12 percent of people have TMJ disorders.
How to fix? “TMJ disorders are treated with exercises, moist heat, anti-inflammatories, muscle relaxants, soft diet, and limited jaw use,” says Merrill.
Trigeminal neuralgia (Tic douloureux)
Trigeminal neuralgia is severe, spontaneous, shock-like pain caused by irritation to the trigeminal nerve, the fifth of 12 pairs of cranial nerves, says Merrill. According to the American Association of Neurological Surgeons, the condition affects 150,000 people a year, especially those over 50.
How to fix? “The initial treatment is anti-seizure medication after an MRI rules out a [brainstem] tumor,” says Merrill. If the medications don’t work, surgery is an option.
“Migraine is a chronic headache causing moderate to severe pain,” says Benavent. “It’s associated with sensitivity to light and/or sound, nausea, and disability during the attacks.” According to the American Headache Society, 13 percent of Americans suffer from migraine.
How to fix? “The attacks can usually be aborted by triptan medications such a sumatriptan [Imitrex],” says Benavent. “Frequent attacks can be suppressed by anti-seizure medications such as topiramate [Topamax] or gabapentin [Neurontin], by beta-blockers such as inderal [Propranolol], or by antidepressants such as amitriptyline [Elavil].”
Herpes Zoster (shingles)
Shingles is a viral infection from the same virus that causes chicken pox, says Dr. Janet C. Lin, a dermatologist at Mercy Medical center in Baltimore, Maryland: “It typically feels painful, burning, or itchy. When it involves the face, it can affect hearing and vision.” Shingles is contagious until the blisters have crusted.
How to fix? People with facial shingles need to see an ophthalmologist to protect their eyes, says Lin. The treatment is anti-viral medications such as acyclovir [Zovirax] and valacyclovir [Valtrex]. It’s best to treat within the first three days to avoid nerve damage.
“People over 60 should seriously consider getting vaccinated against shingles,” says Benavent. According to the CDC, 50% of people will have had shingles by age 85.