Cervicogenic facial pain is discomfort, tingling, numbness or pain, which occurs because of bulging discs in the cervical spine. It has been described with relevant details in “facial tingling or pain caused by bulging discs in cervical spine.” The following excerpt deals with the diagnosis and treatment of this condition.
Diagnosis of cervicogenic facial pain is one of exclusion. It means that, disorders like epilepsy and trigeminal neuralgia are relatively common, so we have to first ensure that a person is not having a variant of these diseases. If no disease can be attributed to cause the facial pain or numbness, one can consider the bulging disc to be a cause of the pain. The prime reason for this approach is because bulging discs are frequently present in normal individuals as well.
The pattern in which pain occurs, is also characteristic in cervicogenic facial pain. The pain typically occurs during extension of the neck (as in looking upwards). Sometimes looking backwards with extreme sideways movement of the neck can also lead to facial pain or tingling and numbness. It is quite common to have neck stiffness due to disuse of neck muscles, because of the pain associated with neck movements.
Picture 1: Bulging Disc in neck on MRI
(Source: Wikimedia Commons)
The investigations like MRI of cervical spine (Picture 1), EEG, and CT scan of brain are normally performed for evaluation and ruling out of other causes and so need not be repeated. Nerve conduction studies can be helpful in establishing an accurate diagnosis. Cervical nerve root blockade by anesthetic agents can be used if diagnosis is in doubt. Complete abolition of pain even at extremes of neck movements confirms the diagnosis of cervicogenic facial pain.
Treatment modalities effective in this disease are directed at the cervical spine, which is the root cause of pain or numbness. Surgery is not necessary in all cases, but, surgical instillation of steroid in cervical region is quite helpful in providing prolonged relief from symptoms. The categories of drugs effective in this condition are
- Antidepressants – Venlafaxine, Duloxetine
- Antiepileptics – Carbamazepine, Gabapentin, Topiramate
- Muscle relaxants – Tizanidine, Thiocolchicoside
- Botox Type A (under evaluation)
Surgical measures like spinal fusion, discectomy, or laminectomy, are infrequently required for sustained pain relief and for those wanting a terminal solution to the problem. However, in majority of cases, medical treatment with drugs along with physical therapy is sufficient for adequate control of symptoms.
- Bulging discs
- Facial Tingling or Pain Caused by Bulging Disc in Cervical Spine
- Tingling and Numbness in the Face and Back of the Head
- Neck Spasm – Causes and Treatment
- Pinched Neck Nerve – Cervical Radiculopathy, Compression