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Q
Facial Headache Frustration?

I've suffered with a facial headache for two years. Migraine medications don't help, physical therapy hasn't helped, decongestants don't help, and extra sleep doesn't help. My doctor doesn't know what to try next. I'm 34, female and in otherwise in good health. Do you have any recommendations?

A
Answer (Published 10/30/2009)

Facial pain can be confusing, frustrating, and difficult to endure. The discomfort can involve facial nerves or be referred from blood vessels or other structures in the head. According to the National Headache Foundation facial pain can be related to true migraine, or muscular syndromes such as temporomandibular joint (TMJ) syndrome, where headache stems from dysfunction of the joint that holds the jaw to the skull (often related to teeth grinding or an unbalanced bite). These unpleasant sensations may also occur in the aftermath of a bout of shingles, rheumatic disease, or trauma (including sinus or dental surgery).

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Yet other causes include sinus problems and trigeminal neuralgia or ("tic douloureux"), a condition that causes sudden, intense facial pain most often described as "stabbing" or "lightning-like," resulting from dysfunction of the trigeminal nerve.

Your experience in trying different modalities that haven't worked is typical. Many patients with this type of pain experiment with various treatments before they find one that works for them.

Rather than recommending any particular therapy, I suggest that you consult a neurologist who specializes in headache treatment. What you need most at this time is a good diagnosis. Once you know what is causing your headaches you may be able to get appropriate treatment without further trial and error.

Andrew Weil, M.D.

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