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Some headache symptoms aren’t obvious. Getty Images
  • A new study finds evidence that headaches can also lead to facial pain.
  • Experts want to highlight how common this symptom is so people don’t wait to get treated.
  • People with cluster headaches were more likely to have facial pain compared to people with migraine.

Having a headache may not all be in your head. A new study in the journal Neurology finds that up to 10 percent of people with headaches also experience facial pain.

Facial pain isn’t well recognized as a headache symptom. Some people with it may think it’s something else and wind up waiting longer for proper diagnosis and treatment, said Dr. Arne May, a neurology professor at the University of Hamburg in Germany.

May’s study examined 2,912 people with primary headaches, which are headaches not from another condition. These include migraine and cluster headache. Participants self-reported data. Those with pain attributed to dental issues were excluded.

Of all participants, 10 percent experienced facial pain. Of 1,935 of people with migraine, 2 percent reported facial pain; of them, 41 percent said most pain was in the face. Among participants with cluster headaches, 15 percent had facial pain; of them, 31 percent had pain mostly in the face.

Those with rare forms of headaches also had facial pain. In fact, 45 percent of the 20 people with paroxysmal hemicrania (severe attacks on one side of the head) experienced facial pain. Facial pain impacted 21 percent of the 42 people with hemicrania continua (continuous pain); and 20 percent of 15 people with short-lasting unilateral neuralgiform (frequent attacks on one side of the head).

The researchers noted six people with constant facial pain on one side of the head and attacks lasting 10 to 30 minutes several times a day. This syndrome has been observed before and is called constant unilateral facial pain with added attacks.

May called for more research on facial pain to determine if it’s a different syndrome all together.

Dr. Yury Khelemsky, an interventional pain specialist focusing on head and neck pain at the Icahn School of Medicine at Mount Sinai in New York, said facial pain is often a result of sensitization of nerves that occurs in people with headaches. It can be caused by trigeminal neuralgia, a condition impacting nerves in the face.

People can have headaches without having pain in the skull, and only experience facial pain. Most often, facial pain triggers headaches. As such, treating it can relieve both ailments. There’s no specific type of headache that makes facial pain seem worse, he added.

Facial pain typically happens around the temples and forehead for most people, though areas under the eyes and in the region of the jaw can be affected, Dr. Morris Levin, a professor and director of the Headache Center at the University of California San Francisco (UCSF) department of neurology, told Healthline.

The upper part of the spine can affect the head and face, or act as a trigger for facial pain and headaches. People are not aware that a lot of head and face pain actually indicate an issue in the neck. “Treating headache and facial pain without addressing the underlying neck issues often misses the mark,” Khelemsky said.

“Pain within the sinus region is often misdiagnosed as ‘sinus headache,’” added Dr. Deena Kuruvilla, an assistant professor of neurology at the Yale School of Medicine. “In the headache world, there is no such thing as sinus headache. It is much more likely to be migraine or another primary headache disorder.”

Overall, most patients do not connect facial pain and headaches, according to Kuruvilla.

“We often hear patients complaining about jaw pain with headaches or migraine and eye pain,” she said.

Facial pain is complicated because trigeminal neuralgia is different from migraine, which is distinct from atypical facial pain. Also, part of the brain stem thought to generate migraine gives signals to a nerve circuit that includes three branches reaching the face.

In cases of isolated facial pain, Kuruvilla said doctors try to rule out causes of pain such as compression of the trigeminal nerve.

“Migraine and facial pain can be very closely intertwined,” she added.

Taking a detailed patient history can alert doctors to red flags and provide an accurate diagnosis.

“I have so many patients who have had unnecessary procedures because of a misconception that facial pain has to be related to jaw or tooth pathology, sinuses, or a primary eye issue,” she said. More patients and providers need to know that facial pain is a common manifestation of all headache disorders. Prior to having invasive services done, patients may benefit from consulting a neurologist or headache specialist, Kuruvilla said.

Taking a good medical history and paying attention to details of symptoms is vital.

Dr. Nina Riggins, a neurologist specializing in headache medicine at UCSF, said she advocates for patients so their other medical issues are not dismissed because they have migraine or other type of primary headache.

“We have to do good detective work with the help of our patients consulting their headache diaries. For example, a sinus infection can contribute to pain in the area of the face, but also can trigger more migraine. I believe that addressing dental, sinus, and other medical problems has the potential to help both facial pain and primary headache by decreasing triggers,” she told Healthline.

May’s team acknowledged limitations with the research, but plans to study the topic more.

“Unfortunately, the study defined facial pain in a way that excluded pain above the eyes and in the forehead… locations where many patients with primary headaches report pain different from that of their typical headaches,” Khelemsky said.

May told Healthline he was surprised to find out how often facial migraine exists and how rare it was for people to experience facial pain without headache or history of headache.

“We are with facial pain patients where we have been with migraine patients 30 years ago,” he said. Back then, they were thought to be a psychological disorder occurring only in females. No one understood why they existed or offered any specific treatment. “I want to change that,” May said.