Conditions We Treat

Headache & Facial Pain

When a headache becomes frequent, severe and disrupts a person’s quality of life, it’s important to seek medical attention. The physicians at UC Headache and Facial Pain Center specialize in uncovering headache causes and triggers. They are leaders in the field, speaking and teaching nationally and internationally, and conducting research to advance treatment.

Facial pain is defined as pain anywhere on the face – areas not behind the hairline including the jaw, sinus and teeth.

Click to expand a topic below and learn more about the different types of headache and facial pain.

 

Headache

Over 36 million Americans suffer from migraine headaches, with over half of those estimated to be undiagnosed. They can be disabling. Migraines often cause people to miss work, family activities and a full life. Migraines are seen three to four times more often in women as men and often start during childhood.

The characteristics of migraines can include:

  • Throbbing pain
  • One-sided pain (present in 2/3 of cases)
  • Moderate to severe pain, lasting four to 72 hours
  • Sensitivity to light and noise
  • Nausea and vomiting
  • Visual change or distortion – seeing an aura, zigzag lines or blind spots (about 15-30 per cent of cases)
  • Pins and needles, tingling sensation in one arm or leg

All symptoms do not need to be present for the headache to be a migraine. An assessment will help determine migraine triggers, which can include a number of factors from food, sleep habits, weather, menstrual periods and psychological issues.

Migraine exists in episodic (occasional) and chronic (continuing) forms, distinguished by the number of migraine headaches that a patient experiences.

Patients with chronic migraine have 15 days per month or more with a headache; with at least 8 days per month experiencing a headache that meets the criteria for a migraine. Patients with episodic migraine have less frequent attacks of migraine headache.

Chronic migraines may be challenging to treat and often require multiple interventions to achieve the best possible treatment results. These interventions might include lifestyle and dietary changes, weight loss, exercise, biofeedback and relaxation techniques, medical therapies, nerve blocks and nerve stimulators.

Migraine treatment can be both preventive, to stop the migraine before it starts, and abortive, treating a migraine attack in progress. Often, a combination of medications is needed to be effective. UC Health experts will determine a customized treatment approach to help a patient return to normal functioning as quickly as possible.

The so-called tension headache occurs in up to 35% of the population.  Even though it is called “tension” headache this does not mean that stress or contraction of muscles in the head are the cause.  Research suggests that these headaches result from an abnormality of pain processing by the brain.

Tension headaches generally occur on both sides of the head in the forehead, temples and back of the head. They have a mild to moderate pain intensity and are described as dull, squeezing or pressing.  It is not uncommon for patients to have some attacks that are migraines and others that are tension headaches.

Tension headaches are treated successfully with over-the-counter medications like aspirin, acetaminophen, ibuprofen or naproxen sodium. Rest, caffeine and withdrawal from the source of stress is also helpful. If the attacks are frequent, they can be treated with preventive medications such as antidepressants, muscle relaxers or anti-inflammatories.

Cluster headaches are one of the least common types of headaches, but also the most debilitating. They are characterized by intense pain. One of the most painful conditions known, someone with a cluster headache may pace or even beat his or her head on the wall. Men suffer more often from cluster headaches than women.

Cluster refers to the cyclical pattern of these headaches. They tend to occur with several clusters of headaches, followed by a period of remission. For example, a cluster patient may have 2-3 months of headaches in the fall of one year and then be headache free until the next year at that time when the headaches return. For other cluster headache patients, headaches may occur with clock-like regularity at exactly the same time each day. A patient may awaken at both 2:00 AM and 4:00 AM each day with these excruciating headaches.

In addition to severe pain, cluster headaches may have these symptoms:

  • Usually one-sided
  • Pain is localized behind the eyes, forehead or upper cheek and temple
  • Tearing eyes, running of the nose and sweating on the same side as the headache
  • The eyelid may swell or droop on the affected side

Cluster headaches do not usually involve an upset stomach or sensitivity to light associated with some migraines.

Medical treatment is effective in about 95 percent of cases, and often involves several therapies such as steroids, verapamil, triptans, seizure medications, oxygen and surgical interventions in patients with difficult cases. The experts at UC Health offer advanced medical management to resolve cluster headaches, as well as surgical options to find relief.

Pseudotumor cerebri headaches can mimic a brain tumor. They are caused by an increase in the pressure of spinal fluid, which is the fluid the surrounds the brain and spinal cord. It is unknown whether the brain produces too much spinal fluid to increase the pressure or if there is a block in absorption of spinal fluid. This condition is first suspected either when a health professional looks in the back of your eye with an ophthalmoscope and notices swelling of the optic nerve or a spinal tap demonstrates increased pressures of spinal fluid. It might also be suspected if a person is overweight and his/her headaches are worse while bending over, coughing or lying down.

This condition is sometimes mistaken for migraines. It’s seen most often in younger, obese women. The headaches are often located throughout the head. Their headaches can often resemble migraine with nausea, vomiting and sensitivity to light and noise. It’s important to seek medical treatment early, since vision loss can occur if left untreated.  Pseudotumor cerebri is usually treated with medication, but sometimes surgery is needed.

Low pressure headaches arise because of a leak of spinal fluid.  There is a fluid-filled sac that surrounds the brain and spinal cord and contains spinal fluid.  The leaks may result from a past spinal tap or epidural, but can also occur spontaneously.  These headaches are typically worse when you stand and better when you lie down. These headaches can be missed for months to years and can be mistaken for chronic migraine.

Our center has particular expertise in the management of these patients and has received regional and national referrals. We have multidisciplinary conferences to discuss the diagnosis and management of persons with spinal leaks and work closely with our neuroradiologists to treat these disorders. Treatments include blood patches, which is where blood is taken from the arm and injected into the area of the leak to seal it. With the blood patch it may be necessary to combine blood with fibrin glue to increase the likelihood of sealing the leak.  We are one of the few headache centers that offer fibrin glue blood patches for treatment of this condition. Rarely surgery is required to seal the leak.

Cervicogenic headaches involve referred pain from a neck or cervical disorder or injury. These headaches are generally located in the back of the head and may occur along with neck pain.  There may be a past history of trauma or whiplash injury to the neck. These headaches are generally managed by nerve blocks, nerve ablations, epidural steroids for herniated discs and rarely surgery.

Some persons with migraine attacks that start in the back of the head may have both migraine and cervicogenic headaches. One may need to treat both the migraine and the cervicogenic headaches to attain an optimal response.

Other types of headaches that can be diagnosed and treated at the UC Health Headache and Facial Pain Center include:

  • Hemicrania Continua
  • Chronic Paroxysmal Hemicrania
  • Rhinogenic Headaches
  • Medication Overuse Headaches
  • Exertional Headaches
  • Hypnic Headaches

Facial Pain

The UC Headache and Facial Pain Center specializes in diagnosing and treating facial neuralgia. A patient who experiences an onset of unexplained facial pain may first be examined for a dental or sinus problem, depending on the type of pain. If such problems are ruled out, further evaluation involving a CT or MRI scan may be performed to rule out the possibility of multiple sclerosis or a tumor. A diagnosis is made after a careful assessment of the patient’s symptoms.

The first line of treatment for trigeminal neuralgia and other facial neuralgia conditions involves medication, including anticonvulsants, which block the nerve from firing. Muscle relaxants may also be prescribed. Medications will provide a long-term solution for about 25 percent of patients with trigeminal neuralgia. Patients who do not achieve long-term pain relief from medications, or who develop unacceptable side effects, may become candidates for surgery.

Glossopharyngeal neuralgia, also called GPN or vagoglossopharyngeal neuralgia, causes severe pain in the back of the throat, nose, tongue, ear, tonsil area and larynx (voice box). It is linked to irritation of the ninth cranial nerve and may be related to a blood vessel compressing the nerve. The attacks of pain are intense and shock-like, occurring without warning, or triggered by movement such as swallowing and speaking.

The infra orbital nerve runs through the bony opening below the eye in the cheekbone. With infra orbital neuralgia, stabbing pain is experienced in these areas as a result of nerve damage.

The occipital nerves run from the top of the spinal cord at the base of the neck up through the scalp. Occipital neuralgia (ON) can occur if this nerve is damaged due to injury, entrapment or inflammation. The pain symptoms of ON can be confused with those of migraines.

ON can cause stabbing, intense pain at the back of the neck and head. Pain usually starts at the base of the scalp and radiates upwards towards the top of the head.  It can be on one or both sides of the head or behind the eye. It can cause sensitivity to light, a tender scalp and pain when moving the neck.

Several medical conditions are associated with occipital neuralgia, including trauma to the back of the head, neck tension or tight muscles, osteoarthritis, neck tumors, cervical disc disease, infection, gout, diabetes and blood vessel inflammation. Many migraine patients have both migraine and occipital neuralgia. Treatment of the occipital neuralgia can dramatically decrease the frequency of migraine.

An accurate diagnosis of this distinct disorder is essential for proper treatment. Treatment of occipital neuralgia includes nerve blocks initially and if they are successful one can consider an occipital nerve ablation (heating up the nerve to make it less responsive) to provide pain relief for 6-9 months. Rarely persons may require an occipital nerve stimulator to control the pain. This is where an electrode is placed surgically on the occipital nerve to provide pain relief by intermittent electrical stimulation of the nerve.

The supraorbital nerve runs through the bone of the face, at the eyebrow, providing sensation just above the eyebrow.  With supraorbital neuralgia, these areas become extremely painful when the nerve is entrapped or damaged.

Trigeminal Neuralgia is one of the most treatable causes of facial pain. It is a severe, intermittent, pain described as burning, electric shock-like pain triggered by factors such as wind, talking, chewing or touching. It affects about one person in every 25,000 and is among the most painful afflictions known. It tends to affect more women than men and is more likely to occur in people over 50. Some people with multiple sclerosis develop trigeminal neuralgia.

The trigeminal nerve carries sensation from the face to the brain. This nerve is made of three separate branches, from the (1) forehead/eye region, (2) cheek and upper lip, and (3) lower jaw, which join together as they travel back to the brain. Most commonly, patients experience pain that shoots to only one of these three on a single side of the face, though some experience pain to both the lower jaw and cheek. It is rare to occur on both sides of the face.

UC Health is a known leader in treating this painful disorder, advancing surgical options to treat TN. The deep knowledge and expertise available through the Headache and Facial Pain Center can bring hope and alleviate pain for anyone suffering from trigeminal neuralgia.

Type II TN is a variant of classic TN in which a longer-lasting pain exists in addition to the classic brief shock-like pain. This tends to develop in patients who have had classic TN, with return of the pain after a pain-free period, sometimes as a recurrence after successful surgical or medical treatment.

The various neuralgia conditions are named for the facial nerve that is involved. The nerve may be damaged by injury, infection or the cause may not be known. It’s important to precisely identify the source of the pain in order to treat it effectively. Specifically, these include Occipital Neuralgia, Supraorbital Neuralgia, Infraorbital Neuralgia, Glossopharyngeal Neuralgia, and Hypoglossal Neuralgia.

Neuropathic facial pain is pain that develops as a result of damage to one or more of the nerves that provide sensation to the face, sinuses, mouth or jaw. The source of the pain may be structural abnormalities, such as tumors, inflammatory conditions such as multiple sclerosis or herpes zoster, or nerve damage from a stroke or dental procedure. Determining the cause of the pain is the key to correct treatment and relief. When a sensory nerve is damaged due to traumatic injury or other causes, the brain may interpret everyday stimulation of the nerve to be painful. For example, brushing one’s teeth could cause sharp, searing pain to the teeth or lip.  The pain can be constant, or come in waves lasting from seconds to hours. Medication is the first line treatment for most patients. Because the cause of this type of pain varies, surgical options can only be evaluated on an individual basis.

Residents of the Cincinnati area are often familiar with sinus pain, linked to the high level of allergens in the Ohio Valley. Patients benefit from the fellowship-trained experts in sinus disorders at the UC Headache and Facial Pain Center.

Sinus pain is caused by inflammation of the lining of the nasal passages and sinuses, often accompanied by nasal drainage. The pain is distinguished as pressure around the eyes and forehead.

The cause of sinus pain is determined first by a physical exam. The physician may perform an endoscopy of the nasal passages, which involves inserting a thin viewing instrument through the nose to examine the nasal passages and sinuses. Allergy testing is sometimes needed.

With sinusitis, an infection of the sinuses, antibiotics are used to treat the infection. Reducing exposure to allergens, using medications such as antihistamines and decongestants to reduce allergic reactions may also be needed to reduce inflammation from allergic reactions.

If a structural problem is contributing to the pain, surgical interventions can correct the issue and provide relief.

Jaw pain falls into two categories: pain from dental causes and temporomandibular disorders (TMD) involving dysfunction of the jaw joint. The pain from these problems shows up in chewing, changes in taste and sometimes a locking feeling in the jaw. It may extend to the neck and around the ear.

The UC Headache and Facial Pain Center has multiple experts who can distinguish between causes of pain, and ensure treatment is efficient and effective.

Whether a dental issue or TMD is causing pain, a personalized treatment plan can be developed that may include a change in diet, anti-inflammatory medications, mouth guard or surgical interventions.

Hemifacial Spasm

Hemifacial spasm is an involuntary contraction on one side of the face, due to injury or compression of the facial nerve by a blood vessel. The condition typically begins with twitching around one eye and then progresses to lower parts of the face on the same side. It is usually not painful, but can interfere with normal expression, vision and cause embarrassment.

Experts at the UC Health Headache and Facial Pain Center can determine the cause of the condition and develop a treatment plan. Treatment normally begins with medication such as anti-convulsant drugs and muscle relaxants. Botox injections can also be used to block the nerve messages that tell the muscle to move. If surgery is needed, microvascular decompression can relieve the symptoms.

 

Atypical Facial Pain

Atypical facial pain shares many features of trigeminal neuralgia, but the pain may be different. The attacks of pain may be longer, and be characterized more as dull, aching, crushing, sharp or squeezing. Atypical facial pain encompasses a wide range of facial problems and possible causes. Diagnosis involves a process of elimination, ruling out factors for other conditions. Medication is usually the first course of treatment.

Find more information on facial pain conditions on the Facial Pain Association website.

Explore the UC Headache and Facial Pain Center