Facial Headaches

‘Facial’ headaches include Sinusitis, Post Herpetic Neuralgia, Trigeminal Neuralgia, Temporomandibular Joint disorders.

Sinusitis

Sinusitis is caused by infection of one or more of the cranial (skull) sinuses. These are the bony inner structures of the skull. Acute sinusitis typically lasts for a few days up to three weeks. The International Headache Society’s criterion of purulent discharge and acute febrile illness is indicative of acute sinusitis (sinus headache). The site of the pain varies according to the location of the infection. Maxillary sinusitis pain is mostly in the cheek, gums, teeth and upper jaw. When pain is presented between and around the eyes this is referred to as ethmoidal sinusitis. Frontal sinusitis pain is seen in the forehead and sphenoidal sinusitis presents with pain at the crown of the head. The pain often has a dull aching quality which is worsened by bending. Very rarely complications can occur such as meningitis or abscesses.

Post Herpetic Neuralgia

Post Herpetic Neuralgia Shingles (herpes zoster virus) can cause pain resulting from various cranial nerves. The pain may start during an acute rash of herpes but the main problem is pain that persists after the herpes rash has gone. Common symptoms include a constant deep pain, with repeated stabs, or needle pricking pain. Even light touch can trigger these symptoms which may be accompanied by itching. Half of patients have no pain after three years.

Trigeminal Neuralgia

Trigeminal neuralgia is considered to be the most common neurological syndrome in the elderly. Women are three times more likely to get it than men. Over 95% of cases are unilateral. The pain is often described as an electric shock or spasm or burning sensation in one or more of the three divisions of the trigeminal nerve. The pain lasts from 2-120 seconds. The ophthalmic division supplies the forehead, eyes and scalp, the maxillary supplies the cheek and the mandibular supplies the lower cheek, lower lip and chin. The condition has been called ‘tic douloureux’ because the facial muscles may twitch. Patients can sometimes have a dull ache as a continuous symptom. The trigger can be cold air, washing the face or cleaning the teeth. The pain can be excruciating. The most common cause is thought to be vascular compression resulting from abnormal arterial roots near the nerve root. MRI scans can confirm this. Other possible causes include malignancy, multiple sclerosis, intrac cranial aneurysms and cranial arteritis.

Temporomandibular Joint (TMJ) Disorders

Each side of the jaw is hinged to the skull and this joint is known as the temporomandibular joint (TMJ). Low grade muscle contraction headaches or migraine can result from temporomandibular joint dysfunction. Possible causes include new dental fillings which may unbalance the bite, grinding the teeth while asleep (Bruxism) and continued stress during the day can initiate and exacerbate the pain.