• Katie Phillips, MD

My Face Hurts ... Is it my Sinuses?

Facial pain can be debilitating, especially if it occurs every day. This can impact your ability to enjoy your daily activities such as eating, socializing and other things you like to do for fun. It can also decrease your sleep quality or your productivity at work. The pain and the subsequent consequences of the pain can leave people desperate for help.




So what causes this facial pain and what can you do about it? The anatomy of the head and neck is quite complex and as a result, the causes of facial pain are numerous. Each of the following paragraphs will go through broad categories of diseases that can lead to facial pain.


Sinus Disease:

One of the main culprits of facial pain is sinus disease. Both a sinus infection and chronic sinus disease can lead to severe facial pain or pressure. Commonly, the sinuses impacted by the infection or inflammation lead to pain in a corresponding area of the face. For example, when the maxillary sinus has disease, patients often feel pain or pressure within their cheeks or teeth. Likewise, disease in the ethmoid sinuses causes pain and pressure between the eyes, disease in the frontal sinuses leads to pain in the forehead and disease in the sphenoid sinuses can lead to pain behind your eyes or on the vertex of your head. When sinus disease is causing facial pain and pressure, other symptoms that are generally present include nasal drainage, nasal congestion, decreased sense of smell, post nasal drip, or fatigue. When you are having severe facial pain or pressure and want to understand if sinus disease is causing this pain, it is best to go see your doctor for evaluation and treatment.


Headaches:

Another common reason patients experience pain in their face is related to headaches. Even facial pain without the typical symptoms of a headache can still be from a headache disorder. Migraines, cluster headaches, as well as other atypical headache disorders such as trigeminal autonomic cephalgias or paroxysmal hemicrania can lead to recurrent facial pain or pressure. Symptoms such as associated nausea, sensitivity to light or sound, dizziness, seeing flashes of light, scalp sensitivity, tearing, or nasal congestion can also be associated with facial pain related headaches. Treatment is usually focused on headache hygiene behaviors and medication to either treat headaches or prevent headaches depending on the severity and/or frequency of headaches. Your primary care doctor or a neurologist may be helpful in treating you if this is the cause of your facial pain.


Orofacial Pain:

Another category of facial pain includes orofacial pain. Orofacial pain may either be from dental problems including infection or disease of the teeth, root of the teeth or gums or from temporomandibular joint (TMJ) disease. The TMJ connects your jaw bone to the base of your skull at the side of your face just below your ear canal (see red arrow in picture below). Disease in this joint can be from many different causes including arthritis, trauma or injury to the jaw itself, or simply your genetics. Often people who grind their teeth can also have pain in this joint. Pain in this joint can be felt as pain in your ear, the back of your neck, or in your face. Treatment is dependent on the exact cause of the injury to the joint, but often conservative treatment (such as resting the joint with diet modifications, pain control, and hot compress) may be enough to improve the pain. See your primary care doctor or dentist if you suspect dental or TMJ disease is causing your facial pain.




Nerve Disorders:

Neuropathy or nerve problems can also be a cause of facial pain. One particular nerve - the trigeminal nerve - provides sensation to the whole face and divides into three separate nerves as it comes out of the skull. These three segments provide sensation to (1) the forehead, (2) the midface, and (3) the chin respectively (see picture below for corresponding locations). If the nerve is injured either from something else compressing the nerve or the nerve has an intrinsic injury, this can lead to facial pain often in a specific area as mentioned above, depending on where that specific nerve provides sensation to the specific area of the face. Nerve pain can sometimes be described as “electric” or “burning” and you will often see people guarding their face to prevent anything from contacting their face to prevent exacerbation of the pain. Conditions that target this nerve include Shingles, Trigeminal neuralgia, Anesthesia dolorosa, among others. Masses - benign tumors or cancerous masses may also push on nerves, causing compression, or grow along the nerve itself resulting in pain. Treatment is dependent on the specific condition. Your primary care doctor can help you figure out if you are suffering from one of these conditions and may make referrals to an ENT, a neurologist, or a pain doctor depending on the specific condition.



As you can see, many things can cause facial pain. If you have pain and it is interfering with your daily life - you should seek help. Your doctor will ask you about the nature of your pain and other associated symptoms. They may also ask that you get a CT or MRI scan to further evaluate your head and neck to look into these conditions or make a referral to a specialist such as an ENT, neurologist, or pain doctor. There are effective treatments for each of the conditions mentioned above, so seek medical care and get an answer.


As always, the content in this blog is meant to be informational and not serve as a substitute for a medical evaluation with a physician.



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