What is cervicogenic facial pain?
Cervicogenic facial pain refers to pain and tingling sensation in the face caused by a bulging of the intervertebral discs in the cervical region of the spine. In other words, a pinched nerve in the neck (cervical) region causes pain in the face since these nerves run to the face. The pain sensations may also affect the neck and the shoulder regions. However, some cases of cervicogenic facial pain may not be accompanied by any pain in the neck.
Signs and Symptoms
The most common symptoms of cervicogenic facial pain are the occurrence of pain, tingling, and numbness in the neck, shoulder and facial regions. However, neck pain is not present in all cases, and the discomfort caused by pain, tingling and numbness may be restricted to the face. Depending on which nerves are affected, there can sometimes be additional symptoms like weakness of the muscles on the face.
Read more on headaches.
Causes of Cervicogenic Facial Pain
The sensations of tingling, numbness, and pain in the face can be caused by any condition that affects the nerves that supply the facial region. The trigeminal cranial nerve, which arises from the brain and supplies the facial region, is primarily responsible for the sensations felt across the face. Therefore, any disorder or disease that affects the normal functioning of the trigeminal nerve can lead to abnormal facial sensations, including pain.
Disorders affecting the trigeminal nerve can cause pain and abnormal facial sensations either unilaterally or bilaterally. In addition, diseases of the brain can also cause abnormal facial sensations. However, brain disorders usually cause tingling, numbness and other abnormal facial sensations on one side of the face (unilateral). Examples of conditions that can cause pain and other abnormal sensations on the face include trigeminal neuralgia, epilepsy, Bell’s palsy, Guillain-Barre syndrome, and multiple sclerosis.
Cervicogenic facial pain can also be caused by a bulging or prolapsed intervertebral disc in the cervical part of the spine. Other cervical spinal conditions that can lead to facial pain include spondylosis, osteoarthritis, spondylolisthesis (also known as slipped vertebra), and stenosis of the vertebral canal. All these conditions can cause compression of the cervical spine, which can affect the trigeminal nucleus either directly or indirectly.
Even though the trigeminal nerve arises from the brainstem (or midbrain) region that is located above the spinal cord, the nucleus of this nerve extends down to the third cervical segment of the spinal cord (abbreviated as C3). There are ganglions of other spinal nerves in this region, and the trigeminal nerve interacts with these nerve cells.
This functional interaction between various nerves leads to the phenomenon of referred pain, due to which pain from the neck region can spread to the face (cervicogenic facial pain) and the head (cervicogenic headache). Thus, compression of the cervical spine can lead to pain in the neck and referred pain in the facial region.
Sometimes, neck spasms caused by the involvement of the trapezius and the sternomastoid muscles can also lead to facial pain. The trapezius and the sternomastoid muscles are innervated by a cranial nerve known as the accessory nerve. The nucleus of the accessory nerve lies near the nucleus of the trigeminal nerve in the cervical region of the spinal cord.
There is a functional interaction between these nuclei, which causes referred pain in the facial region when the trapezius and sternomastoid muscles undergo spasm. Neck movements and posture also play an important role in the development of cervicogenic facial pain. Most cases of cervicogenic facial pain are unilateral. However, bilateral pain can also occur.
Diagnosis: Tests and Scans
Cervicogenic facial pain refers to facial pain arising from causes within the cervical region. However, as mentioned previously, facial pain can be caused by a number of disorders that affect the trigeminal nerve or brain functions. Cervical region is not always involved in these cases. Therefore, diagnosis of cervicogenic facial pain depends on excluding the other probable causes of facial pain. MRI of cervical spine, CT scan of brain, and EEG can be performed to check for the causes of facial pain.
Trigeminal neuralgia and epilepsy are relatively common conditions that can cause facial pain. Therefore, one must first exclude the presence of these conditions before considering bulging cervical discs as the potential cause of facial pain. This strategy of basing diagnosis on exclusion of other common diseases is based on the fact that many people with bulging cervical discs do not have facial pain.
Only in some cases, facial pain is caused by a bulging of the intervertebral discs in the cervical region. In fact, it was assumed earlier that bulging cervical discs are not related in any way to facial pain, and patients were labeled as overly sensitive. Sometimes, these patients were also accused of feigning pain in order to get insurance claims.However, many studies have now documented the occurrence of pain, numbness and tingling in the face in patients with bulging cervical discs. Pain in the neck may or may not occur along with facial pain in these cases.
Cervicogenic facial pain has a characteristic pattern that may aid its diagnosis. The pain in these cases usually occurs upon extension of the neck (such as when one looks upwards or sideways with extreme movements of the neck). Tingling and numbness may also occur upon neck extension. Because of these painful neck movements, the patients may not use their neck muscles frequently, leading to stiffness of the neck.
To confirm the diagnosis of cervicogenic facial pain, nerve conduction studies may also be carried out. The cervical nerve root is blocked by anesthesia, and extreme neck movements are conducted in this state. If the pain caused by extreme neck movements is completely abolished upon anesthesia-induced cervical nerve root blockade, then the diagnosis of cervicogenic facial pain is confirmed.
Treatment of Cervicogenic Facial Pain
The treatments for cervicogenic facial pain are directed at the cervical spine. Medications and surgery are the two main treatment modalities for this condition. In the majority of cases of cervicogenic facial pain, medications (combined with physiotherapy) are able to provide sufficient relief from the painful symptoms. However, in some cases, surgery is the preferred option. Medications for treatment of cervicogenic facial pain include:
- Muscle relaxant drugs such as thiocolchicoside and tizanidine.
- Antiepileptic drugs such as gabapentin, carbamazepine, and topiramate.
- Antidepressant drugs such as duloxetine and venlafaxine.
- Botox (type A) is also being considered for treating this condition.
Surgical options include discectomy, spinal fusion, and laminectomy. It is an option for patients who need long-term sustained relief from the pain.