Facial Pain Syndromes
Trigeminal Neuralgia

What is Trigeminal Neuralgia? 

It is a disorder of the trigeminal nerve which is the fifth and largest cranial nerve. The trigeminal nerve is one of 12 pairs of cranial nerves that originate at the base of the brain. The nerve has three branches that conduct sensations and more than one nerve branch can be affected by the disorder.

What causes Trigeminal Neuralgia? 

Trigeminal neuralgia occurs in many patients because of tortuous blood vessels that compress the trigeminal root as it exits the brain stem. This compression causes the wearing away of the protective coating around the nerve (the myelin sheath). Other causes of Trigeminal Neuralgia are: normal aging process and can occur in people with multiple sclerosis. Frequently, the cause of trigeminal neuralgia is unkinown. Viral syndromes such as herpes zoster, Dental procedures, cranial surgery/injury, degenerative diseases, autoimmune diseases as well as other conditions can cause pathology/abnormal functioning of the trigeminal nerves.


Signs and Symptoms: 

  • Sudden, severe, electric shock-like, stabbing pain (Type I TN)
  • Usually unilateral (one side)
  • Constant, aching, or burning pain (Type 2 TN

Testing: 

Tests that are recommended are often intended to rule out other possible medical conditions.

  • Plain X-rays
  • MRI
  • Labwork
  • Diagnostic Injection

Diagnosis: 

At present, there is no widely accepted, standard test to correctly identify all trigeminal neuralgia conditions. In most cases, however, a targeted history and physical examination of the head, neck, face and jaw provide information useful for making a diagnosis.

Treatments: 

  • Drug Therapy
  • Physical Therapy
  • Trigeminal nerve blocks
  • Gasswerian ganglion blocks
  • Cryotherapy
  • Radiofrequency thermocoagulation
  • Neurostimulation trail and implantation
  • Radiosurgery
Temporomandibular Joint (TMJ) Dysfunction

What is TMJ Dysfunction?

TMJ is characterized by pain in the jaw, joint and surrounding tissues and limitations in the jaw movements, locking of the jaw, painful chewing, inability to open or close the mouth completely, and severe limitation in use of the jaw.

The pain itself can radiate into the mandible, ear, neck, and tonsillar pillars. You have two TMJ’s: one in front of each ear, and one that connects the lower jaw bone (the mandible) to the skull.

What causes TMJ Dysfunction? 

Not all causes for TMJ Dysfunction are known, some possible causes or contributing factors are: injuries to the jaw/head/neck, various forms of arthritis, dental procedures, genetics, hormones, low-level infections, autoimmune diseases, stretching of the jaw and clenching or grinding of the teeth. Because motor vehicle accidents injure many structures of the body, they are frequently a cause of TMJ syndrome.


Signs and Symptoms: 

  • Dull, sharp, aching or severe pain in the jaw joint
  • Being unable to open the mouth comfortably
  • Clicking, popping or grating sounds in the jaw joint
  • Locking of the jaw when attempting to open the mouth
  • Headaches
  • A bite that feels uncomfortable or “off”
  • Neck, shoulder and back pain
  • Swelling on the side of the face

Testing: 

Tests that are recommended are often intended to rule out other possible medical conditions.

  • Plain X-rays
  • MRI
  • Labwork
  • Physical examination
  • Diagnostic Injection

Diagnosis: 

At present, there is no widely accepted, standard test to correctly identify all TMJ conditions. In most cases, however, a targeted history and physical examination of the head, neck, face and jaw provide information useful for making a diagnosis.

Treatments: 

Cervicocranial Syndrome

Cervicocranial Syndrome is due to vertebral instability and or dysfunction related to trauma of any source including surgery, which affects the function of the nerve cell aggregations and reflexes located in the neck just in front of the vertebrae as well as spinal cord.

Vertebral instability or misalignment as well as dysfunction occurs because the ligaments that support the neck become weakened or injured. This condition may develop in people who spend a good portion of their day hunched over while working, sustained traumatic injury to head and neck or surgery of either head or neck.

Any activity that precipitates the head forward posibtion and puts the cervical vertebral ligaments in a stretched position will cause the ligaments to weaken over time.


Signs and Symptoms: 

  • Vertigo
  • Cephalea/Headache
  • Tinnitus
  • Facial pain/facial numbness/swelling on one side of the face
  • Otalgia/ear pain
  • Dysphagia(difficulty swallowing)
  • Dysfunction of equiloibrium
  • Loss of voice/hoarseness
  • Neck pain
  • Severe fatigue/Muscle weakness
  • Sinus congestion
  • A sense of the eyeball being pulled out
  • A sense of pins-and-needles sensation of the hands and forearms
  • Dental pain
  • Lacrimation (tearing of the eyes)
  • Blurred vision
  • Shoulder pain
  • Nausea/Vomiting
  • Localized cyanosis of the face (bluish color)

Testing: 

Diagnosis: 

A comprehensive medical history and thorough physical exam by clinician, along with appropriate testing to determine there are no pathogenesis lesions of the joints of the skull, which may be responsible for pain and dysfunction in the segmental areas.

Treatments: 

Myofascial Syndrome (MPS)

MPS is a fancy way to describe muscle pain. It refers to pain and inflammation in the body's soft tissues. Myofascial pain is a chronic condition that affects the fascia (connective tissue that covers the muscles) and or the muscle fibers/spindles themselves. Myofascial pain syndrome may involve either a single muscle or a muscle group.

In some cases, the area where a person experiences the pain may not be where the myofascial pain generator is located.  There are associated trigger points in one or multiple muscles which maintain this pathology much like a reflex operating continuously.

Factors which can increase risk of myfascial pain (MPS):


Signs and Symptoms: 

  • Deep, aching pain in a muscle
  • Pain that persists or worsens
  • Muscle stiffness
  • Joint stiffness near the affected muscle
  • Area of tension in your muscle that may feel like a knot or tight spot and may be particularly sensitive to touch
  • Difficulty sleeping due to pain.

Testing: 

  • History and Physical exam
  • CT or CAT scan
  • MRI
  • Discography
  • Myelograms
  • EMG/NCV
  • Bone scans
  • Ultrasound imaging

Diagnosis: 

A comprehensive physical exam and medical history by clinician, along with appropriate testing to determine treatment is required.

Treatments: 

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