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General Medical Questions
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Question : I have a sharp pain on the left side of my face that comes and goes. It occurs on and off. What might this be? Is there a cure or treatment?
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The Trusted Source
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Howard LeWine, M.D.

Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.

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October 01, 2012
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A:

There are many possible causes of facial pain. But sharp, on and off pain on one side of the face is a good description of a condition called trigeminal neuralgia (or tic douloureux).

It is caused by an irritation or pinching of the trigeminal nerve (also called the fifth cranial nerve). The cause is often unknown. But in some cases it’s thought that a blood vessel that normally travels near the nerve actually squeezes it. Rarer causes are multiple sclerosis or a tumor. Trigeminal neuralgia is more common in women than men. And it’s more common in older adults.

To make the diagnosis, your doctor will need to know more about your symptoms. These include:

  • The precise location of the pain
  • Any recent injuries or dental problems that came before the pain
  • A history of rashes or sores on the skin or in the mouth
  • Whether there are other areas of pain, numbness or tingling
  • Vision problems
  • Difficulty with walking or coordination

Your doctor may recommend additional tests, such as an MRI, after a thorough examination (especially the nerve function around the face).

Treatment includes drugs commonly prescribed for painful nerve disease, such as carbamazepine (Tegretol) or gabapentin (Neurontin). Or your doctor may prescribe standard pain relievers, such as acetaminophen, ibuprofen or codeine-type medicine.

If none of the medicines is effective, your doctor may suggest minor surgery. This can interrupt the painful nerve signals from the trigeminal nerve or move the blood vessel that is pressing on the nerve. If another condition is discovered, such as multiple sclerosis, treatment of that condition may improve the facial pain.

The good news is that if this is the diagnosis, the prognosis is good. About 80% of people with trigeminal neuralgia dramatically improve with medicine alone. And for the rest, surgery or other treatments often work well.

Your symptoms sound typical of trigeminal neuralgia. But other possible causes of facial pain include:

  • Herpes zoster (or shingles)
  • Dental disease, such as a gum infection
  • Sinus congestion or infection
  • Salivary gland blockage

Since treatment depends on the diagnosis, see your doctor for a full evaluation.

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