(Migraine, Occipital Neuralgia, Trigeminal Neuralgia and other forms of chronic facial pain)
When Pain Affects the Head… Or Face
Chronic head or facial pain can have a profound impact on quality of life. In some cases, these are
Migraine
Migraine is a form of primary headache (i.e., not due to other diseases) that affects approximately 12% of the population. It is characterized by:
- Throbbing or pounding pain, often unilateral
- Recurring episodes lasting 4–72 hours
- Often accompanied by nausea, vomiting, photophobia (light sensitivity) and phonophobia (sound sensitivity)
- In some cases preceded by visual or sensory aura
Migraine is a complex neurological disease, not just a “headache”.
Trigeminal Neuralgia
Trigeminal nerve neuralgia is a rare but extremely painful form of facial pain. It presents with:
- Sudden and lightning-like bursts of pain, similar to an electric shock
- Usually affects one half of the face (jaw, cheek, forehead)
- Attacks can be triggered by simple stimuli: talking, chewing, washing the face
- The pain lasts from seconds to minutes, but can repeat dozens of times per day
It is caused by irritation of the trigeminal nerve, which transmits facial sensation.
Other Causes of Chronic Facial Pain
- Chronic tension headache
- Cervicogenic headaches (related to cervical disorders)
- Occipital neuralgia
- Post-herpetic neuropathic pain (e.g., after shingles)
- Temporomandibular dysfunction (TMJ)
How is it Diagnosed?
- Specialized neurological or pain assessment
- Neurological examination and examination of the face and musculature
- In some cases: brain MRI, electromyography or CT scan
What Treatments are Available?
Pharmacological Treatment
- Preventive medications for migraine (antiepileptics, antidepressants)
- Triptans for acute attacks
- Anticonvulsants or carbamazepine for trigeminal neuralgia
TENS (Transcutaneous Electrical Nerve Stimulation)
- A small device that stimulates nerves through the skin with mild electrical impulses.
- It can help reduce pain by modulating pain signals locally, in a safe and non-invasive way.
Mini-invasive Interventional Therapies
- Nerve blocks of the trigeminal or greater occipital nerve
- Peripheral or central neuromodulation in severe and refractory cases
What is the Prognosis?
With a correct diagnosis and targeted treatment, most patients can achieve effective pain control. Modern therapies, even mini-invasive ones, allow us to reduce the frequency, intensity and social impact of pain.
