FACIAL PAIN & NERVE-RELATED HEADACHES
Facial pain and nerve-related headaches can be some of the most intense and confusing types of head pain.
These conditions often overlap with migraines or cluster headaches, but they have distinct causes and treatment options. This page is designed to help you understand the different types of nerve-based facial pain, what symptoms to look out for, and how they are typically managed.
Trigeminal Neuralgia (TN)
Trigeminal neuralgia is a chronic condition that causes sudden, severe, electric-shock-like pain on one side of the face. It’s often triggered by mild stimuli such as brushing teeth or a breeze on the cheek. The pain typically affects the lower face and jaw, but may also impact the nose and eyes. It’s caused by irritation or compression of the trigeminal nerve, sometimes due to a nearby blood vessel.
Glossopharyngeal Neuralgia (GN)
This rare condition affects the ninth cranial nerve, which supplies the throat, tonsils, and part of the tongue. Attacks are often sudden and severe sharp, electric-shock-like pain on one side of the throat, back of the tongue, ear, or jaw. These episodes can be triggered by swallowing, coughing, or even talking.
While often confused with trigeminal neuralgia, GN tends to involve deeper throat and ear pain.
MedlinePlus offers a clear overview of GN, its causes, and treatment options:
Occipital Neuralgia
Occipital neuralgia typically causes a sharp, electric‑shock or tingling pain that starts at the base of the skull and may radiate forward toward the scalp or eye. Triggers include even the lightest touch, such as washing your hair or lying on a pillow.
Persistent Idiopathic Facial Pain (PIFP)
Unlike the sharp, stabbing pain of trigeminal neuralgia, atypical facial pain, now referred to as Persistent Idiopathic Facial Pain (PIFP) is defined in the ICHD‑3 as:
“persistent facial and/or oral pain, with varying presentations but recurring daily for more than 2 hours per day over more than 3 months, in the absence of clinical neurological deficit.”
Source: International Classification of Headache Disorders, 3rd edition (ICHD‑3)
Ramsay Hunt Syndrome
Ramsay Hunt Syndrome is a complication of shingles that affects the facial nerve near the ear. It typically causes a painful rash on one side of the face, along with facial paralysis or weakness. Some people also experience hearing loss or ringing in the affected ear. This condition needs prompt medical attention. The chances of full recovery are much higher when treatment begins early.
Cluster-Tic Syndrome
Cluster‑tic syndrome is an exceptionally rare headache condition that combines brief, electric-shock facial pain similar to trigeminal neuralgia, followed almost immediately by a cluster headache with autonomic symptoms such as tearing or nasal congestion. Diagnosis is challenging, and treatment often requires both anticonvulsant and cluster headache therapies.
“Cluster‑tic syndrome is a disorder characterized by three types of pain attacks: one resembling trigeminal neuralgia, the second resembling cluster headache, and a third mixed pattern where neuralgic pain is immediately followed by headache with autonomic signs.”
Source: Alberca & Ochoa, Neurology
SUNCT
(Short-lasting Unilateral Neuralgiform Headache Attacks with Conjunctival Injection and Tearing)
SUNCT is a rare and intensely painful headache disorder characterized by very short but frequent attacks, often dozens to hundreds each day of sharp pain around one eye, accompanied by tearing and eye redness. It’s classified under trigeminal autonomic cephalalgias (TACs).
SUNCT is usually diagnosed based on clinical symptoms and by excluding other causes of short-lasting headache. An MRI of the brain is often recommended to rule out secondary conditions, since symptoms can mimic other serious disorders. Diagnostic criteria require frequent, brief, one-sided pain attacks around the eye, always accompanied by redness and tearing.
Source: American Migraine Foundation
Raeder’s Paratrigeminal Syndrome
This rare condition causes pain on one side of the face, often around the eye, and may be accompanied by a droopy eyelid or a smaller pupil. It’s thought to involve a nerve pathway near the eye and brain.
Source: Medscape - Raeder Paratrigeminal Syndrome Overview
When to Seek Help
Any sudden, severe facial pain should be assessed by a doctor, especially if it’s interfering with eating, talking, or daily life.
At ALLOR, we do not treat the nerve-related and facial pain conditions listed on this page with Botulinum toxin or any other intervention. These types of headaches and neuralgias are complex and require assessment and management by your General Practitioner (GP) and/or a specialist neurologist.
If you're experiencing any of these symptoms, we strongly recommend seeking medical advice from your doctor for proper diagnosis and treatment options.
You can also find helpful links on our migraine resources page for further information.
Botulinum toxin injections are prescription only medicine for the treatment of frown lines, horizontal forehead lines, and crow’s feet round the eyes. Botulinum toxin injections have risks and benefits. Ask your doctor if botulinum toxin injections are right for you. If you have side effects, see your doctor. You will need to pay for your botulinum toxin injections and clinic fees will apply. For details on precautions and side effects consult your doctor or go to www.medsafe.govt.nz. Botulinum toxin injections last about 4 months and further courses of treatment may be necessary. Should only be administered by trained medical professionals.