[43F] With extreme facial pain and numbness

Patient Description

A 43-year-old female presents with extreme pain on the left side of her face, lasting from 30 seconds to 45 minutes. The pain occurs suddenly and is often triggered or worsened by exposure to cold air or touching the face. It is more frequent in the late evening and at night. The patient also reports numbness on the left side of her face throughout the day for several years, described as a loss of feeling in certain areas without visible drooping. The patient had a significant fall at age 13, resulting in torn ligaments in the neck on the right side, but these symptoms are recent. There is no muscle weakness, difficulty with facial movements, changes in vision, eye pain, recent dental procedures, or infections. The patient was hospitalized last year for diverticulitis with ruptured polyps and was first diagnosed with the condition last year. She has no allergies, is not taking any medications for nerve pain or chronic conditions, and uses over-the-counter pain relievers like naproxen or Tylenol as needed. No recent changes in overall health, stress levels, diet, or exposure to new environmental factors.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, here are some possible explanations:

  • Trigeminal Neuralgia: This condition is characterized by sudden, severe facial pain that can be triggered by touch, chewing, or exposure to cold air. The pain is usually brief but can be extremely intense. Numbness is less common but can occur. Typical treatments include medications like anticonvulsants or muscle relaxants, and in some cases, surgical options may be considered.

  • Post-Traumatic Neuralgia: Given your history of a significant neck injury, it's possible that nerve damage from that incident could be contributing to your current symptoms. This type of pain can be managed with medications, physical therapy, and sometimes nerve blocks.

  • Atypical Facial Pain: This is a less common condition that can cause chronic facial pain without a clear cause. It can be challenging to diagnose and treat, often requiring a multidisciplinary approach including medications, psychological support, and sometimes physical therapy.

What you can do

While it's important to consult a healthcare professional for a formal diagnosis and treatment plan, here are some steps you can take in the meantime:

  1. Keep a Symptom Journal: Use MDandMe to journal your symptoms, track their frequency and intensity, and note any potential triggers. This information can be very helpful for your healthcare provider.
  2. Avoid Triggers: Try to avoid known triggers like cold air and touching your face. Wearing a scarf or mask in cold weather might help.
  3. Pain Management: Continue using over-the-counter pain relievers like naproxen or Tylenol as needed, but be mindful of the recommended dosages.
  4. Warm Compresses: Applying a warm compress to the affected area may help alleviate some of the pain and discomfort.
  5. Stay Hydrated and Maintain a Healthy Diet: Good overall health can sometimes help mitigate symptoms.

What you should look out for

Seek medical attention if you experience any of the following:

  • Increased Frequency or Intensity of Pain: If your pain becomes more frequent or severe, it's important to consult a healthcare provider.
  • New Symptoms: If you develop new symptoms such as muscle weakness, vision changes, or difficulty with facial movements, seek medical attention promptly.
  • Ineffectiveness of Over-the-Counter Medications: If over-the-counter pain relievers are no longer effective, it may be time to explore other treatment options with your healthcare provider.

Remember, while I can provide information and suggestions, it's crucial to consult a healthcare professional for a formal diagnosis and appropriate treatment.

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3 mo ago


People Also Ask


What is trigeminal neuralgia and how is it treated?

Trigeminal neuralgia is a chronic pain condition affecting the trigeminal nerve in the face, causing sudden, severe facial pain. It is often treated with medications such as anticonvulsants or muscle relaxants, and in some cases, surgical options may be considered.


Can a past neck injury cause facial pain years later?

Yes, a past neck injury can potentially cause facial pain years later if there was nerve damage. This is known as post-traumatic neuralgia, and it can be managed with medications, physical therapy, and sometimes nerve blocks.


What are some common triggers for facial pain conditions like trigeminal neuralgia?

Common triggers for facial pain conditions like trigeminal neuralgia include exposure to cold air, touching the face, chewing, or even speaking. Identifying and avoiding these triggers can help manage the condition.


When should I seek medical attention for facial pain?

You should seek medical attention for facial pain if the pain becomes more frequent or severe, if you develop new symptoms such as muscle weakness or vision changes, or if over-the-counter pain relievers are no longer effective.

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