The face is aching - Causes, symptoms and treatment. MF.

Facial pains( prozopalgia) are pains in the face area of ​​a different cause.

For what reasons does the face of

hurt? A person's face has a rich innervation of the branches of the trigeminal nerve. Sympathetic innervation of the face is carried out from segments C8-D2-3 of the lateral horns of the spinal cord, from there the preganglionic fibers go to the upper cervical node. Some of them, which have not been interrupted, reach the cranial vegetative nodes - ciliary, pterygopod, sublingual, submandibular, ear, where they are interrupted and branched in the tissues of the face. Parasympathetic innervation of the face is carried out by the structures of the brain stem, nuclei of the nerves - 3, 7, 9, 10, cranial nerves, the fibers from which are directed to the nervous ganglia. The nervous ganglion( node) is a complex nerve formation - a peripheral reflex center, which includes sensory, motor( motor), parasympathetic and sympathetic cells. Therefore, the defeat of the node is manifested by all disorders - sensory, impaired movement, pronounced vegetative reaction - redness, sweating, tear and salivation, paresthesia( sensation of crawling on the skin, burning tingling. ..).The listed ganglia have a close connection with the trigeminal nerve: the ciliary - with the first branch, the winged - with the second branch, the ear and the submandibular - with the third.

Any pathology in the face, head and neck can cause pain in the face.

The most complete classification of facial pain

1. Somatalgia:
- trigeminal neuralgia;
- prozopalgia in the defeat of other nerves, with somatic sensitive fibers - neuralgia of the glossopharyngeal, upper laryngeal nerves.

2. Sympatalgia - pain in the face along the arterial trunks, burning, pulsating, accompanied by pronounced vegetative reactions:
- vascular facial pain( facial migraine, carotid-temporal syndrome. ..)
- sympathy associated with direct damage to the autonomic innervation of the face( auriculo- temporal syndrome, neuralgia of the pterygoid, ear node. ..)

3. Combined facial pains.

4. Prozopalgia in hypochondria-depressive states, hysteria. ..

5. Prozopalgia in case of internal organs disease.

Diseases that cause pain in the face

Facial migraine is characterized by a long duration of a pain attack - hours, days, the absence of horn zones( points, which can trigger a pain attack), the presence of nausea, vomiting, pain localization more consistent with the course of blood vessels than nerves. Occurs when the upper cervical sympathetic node is affected, the sympathetic plexus of the external carotid artery and its branches. The pain is localized more in the eye sockets, upper jaw, ear, less often - in the bridge of nose, nose, temples, forearm, arm, accompanied by pulsation of the temporal and carotid arteries, lowering blood pressure. A headache is also possible on the corresponding side.

Syndrome Charlene ( neuralgia neuralgia) is characterized by acute pain in the orbit, the eyeball, with the spread( irradiation) in the nose for 20 minutes to hours, often at night. Ganglionitis of the ciliary node is accompanied by herpetic eruptions on the skin of the forehead and nose, it is possible to damage the eye with the development of keratitis, iridocyclitis. The epicenter of pain is the inner corner of the eye. Pressing on this point can cause an attack of pain. The most common cause of the disease is etmoiditis, frontalitis, hypertrophy of nasal concha, viral infection, herpes. To confirm the diagnosis and relieve pain, you can lubricate the nasal mucosa in the top nasal cone with dicaine and adrenaline, while you can also drip your eyes.

Sluder Syndrome ( ganglionitis of the winged nodulus) is characterized by the appearance of pain in the upper jaw, at the root of the nose, around the eye, pain is more prolonged than with neuralgia of the trigeminal nerve. Curved zones are absent. Vegetative manifestations are expressed: often the nasal mucosa turns red, there are discharge from one nostril, less often - lacrimation, salivation, sneezing, edema of the facial skin. Due to the links of the node with 1-2 branches of the trigeminal nerve and the upper cervical node, the picture of the attack can change, the pain can radiate to the occipital region, neck, and the foreleg. To confirm the diagnosis, you can lubricate with a solution of dicaine mucosa of the posterior sections of the middle nasal passage.

Freya Syndrome ( neuralgia of the mandibular nerve) - burning pain is not long( 20 - 30 minutes), mainly in the temporal and parotid region, there are no horn points, during meal appears profuse sweating( hyperhidrosis) and redness( hyperemia) in the parotid region,hyperthermia( fever), hypersensitivity( hyperesthesia).These are local vegetative-vascular disorders in the parotid region. Most often the cause of the syndrome are parotid gland diseases( infectious, abscess, after surgery. ..)

Neuralgia of the glossopharyngeal nerve - pains concentrated in the root of the tongue, tonsils, posterior pharynx wall, around the angle of the lower jaw, taste changes, swallowing is difficult. At the peak of the development of an attack, syncope, bradycardia, and lowering of blood pressure are possible. The attack can be suppressed by the dication of the root of the tongue, tonsils.

Ganglionitis of the upper joint - paroxysmal pain from a few minutes to a day, pain in the neck, occiput, foreleg, perivascular in the face. On examination, Horner's symptom is identified( ptosis-lowering of the upper eyelid, miosis - pupil narrowing, enophthalmus - eyelid drooping), soreness of the paravertebral points in the cervical spine, impaired sensation.
The node is damaged in infections( with herpetic infection - there are bubble rashes in the zone of innervation), intoxications, injuries of the cervical region. Horner's symptom may appear in other serious diseases of the tumor of the apex of the lung, thyroid gland, aortic aneurysm. .. Therefore, when such a symptomatology appears, it is necessary to consult a doctor and be examined.

Glossology, glossodynia - pain in the tongue, discomfort, burning, tingling, numbness, long and persistent. Pain can also be present in the oral mucosa - stomatalgia. More often this condition occurs in the pathology of the gastrointestinal tract.

The pain syndrome with teeth diseases is long-lasting, the pain can radiate from the tooth all over the jaw, into the neck and even the scapula. The pains are provoked by cold water, biting, possibly raising the temperature. Pain in the face can occur with pulpitis, periodontal disease, bite pathology, after prosthetic teeth and as a complication of anesthesia.

Pain in the face with diseases of the paranasal sinuses of the nose - sinusitis, frontalitis, pansinusitis - pains( often bursting in nature) in the zones above the sinuses of the nose, with irradiation in the eyes, possibly in the ears, shortness of nose or breathing in the nose,deterioration of general well-being, curved zones are absent, painful syndrome is permanent - one or two-sided.

Front. Sinusitis.

Postherpetic neuralgia is a frequent complication of acute herpetic infection, acute sharp pains occur in the place where there were bubble rashes, pain can persist for a long time. The pain is based on inflammatory changes or damage to the ganglia of the posterior roots of the spinal cord and peripheral nerves in the affected areas.

Temporal arteritis is an acute onset with an increase in temperature and pain in the palpation of the temporal artery, pain in the temple along the course of the artery from hours to days. Within a few weeks of the disease, the wall of the artery thickens, "knots" are formed. Perhaps complication with the development of thrombosis of the vessels of the eye, a violation of the blood supply to the optic nerve and the development of blindness. It is more common in the elderly, combined with rheumatic polymyalgia. In addition to the general analysis of the blood - it is necessary to study for rheumatic tests.

Pain in the face, eyeball can be with eye diseases - inflammatory diseases, injuries, tumors, glaucoma, optic neuritis. With the attack of glaucoma - severe pain in one eye, can be irradiated to the temple, accompanied by reddening of the eye, dilated pupil, lethargic pupillary reactions, decreased vision, "circles" before the eye when looking at the light, photophobia. With conjunctivitis, the patient feels a burning sensation in the eye, the eye turns red, perhaps souring and discharge from the eye, puffiness of the eyelids.

Pain in the face can be a reflected pain in the disease of internal organs - with angina pectoris, gastric ulcer. .. according to Zakharyin-Ged zones( reflex pains).

Zakharyin Zones - Geda on the face:

1 - hypermetropia;
2 and 8 - glaucoma;
3-stomach;
4-cavity of the nose;
5 - the back of the tongue;
6 -throat;
7-front half of the tongue;
9 -corn, front eye chamber, nasal passage;
10-thoracic cavity organs.

What kind of examination is prescribed if the face is aching

If any pain appears in the face of any localization, you should consult your doctor and describe your symptoms in detail. Depending on the complaints and objective examination, the doctor will prescribe the examinations you need. It is possible to administer a general blood test. Increased number of leukocytes and accelerated ESR( sedimentation rate of erythrocytes) will indicate the presence of an inflammatory process - sinusitis, frontal sinusitis, tonsillitis, etmoiditis. .. Revmoprobes - positive rheumatic tests indicate a rheumatic active process( for example, with temporal arteritis).

Probably the appointment of radiography of the paranasal sinuses in case of suspected sinusitis. On radiographs, the darkening of the affected sinus will be seen. Thus the patient goes to the doctor - the otolaryngologist.

For pain with localization in the eye socket, visual disturbances, computer tomography will be required to exclude( confirm) the possible pathology of the brain - tumors, magnetic resonance imaging( possibly in angiography) - to exclude( confirm) multiple sclerosis, cavernous sinus thrombosis, aneurysmvessels of the brain. ..

Consultation of specialists - ophthalmologist, otolaryngologist, dentist, rheumatologist, neurosurgeon may be required.

Treatment of pain in the face of

Self-medication is dangerous because of a possible omission of a serious disease and the development of complications. It is necessary to consult a doctor and be examined.

For the treatment of neuropathic pain, anticonvulsants are used - carbamazepine, finlepsin, gabapentin. Non-steroidal anti-inflammatory drugs such as diclobert, xefokam, imeth. .. and preparations of group B are also used.

If pain is a symptom in any described disease, these drugs are prescribed in the complex treatment of the underlying disease.

With established diagnosis and chronic course, for example trigeminal neuralgia during exacerbation, self-administration of prescribed medications is possible: gabapentin( gatonin, gabagamma, gabantine, tebantinum) 300 mg 1 tablet in the evening, with a possible dose increase - 1 tablet 3 times a day, dicloberte- 1 tablet after meals, neurovitamin 1 tablet 3 times a day.

With migraine, you can independently take nomigrena, antimigrena, rapimiga.

For the treatment of neuralgia use reflexology - acupuncture, su-jok, acupressure;Physiotherapeutic procedures - electrophoresis, darsonval;psychotherapy, antidepressants, tranquilizers.

The doctor neurologist Kobzeva S.V.