Facial Tingling or Pain Caused by Bulging Disc in Cervical Spine

Can facial numbness or pain arise from a bulging disc ? Yes.

It is interesting to note, that cervical disc bulges can also lead to facial symptoms (1). It is frequently seen as neck pain involving the shoulder and also extending to the face. However, sometimes it may even occur without any neck involvement. Earlier it was thought to occur due to an overt sensitivity of the patient. Sometimes it was even considered that the patient is feigning the pain for better insurance claims. And thus, the patient had to unnecessarily suffer an emotional predicament in making people believe that he/she does suffer from pain. And this was even after the cause of the disease (bulging discs), had already been seen on MRI but frequently ignored by physicians as normal. However, it has been documented in many research papers, that bulging cervical discs can cause facial pain, tingling or numbness along with neck pain or even without it. This is called cervicogenic facial pain.

Causes of Facial Tingling and Numbness

Facial sensations are carried by the trigeminal nerve, which is a cranial nerve (arises directly from the brain)(Picture 1). Thus, abnormal facial sensations can arise due to a disease of the trigeminal nerve or of the brain. Facial pain is mainly due to disorders of the trigeminal nerve, which can be single sided or bilateral, but brain disorders are typically associated with abnormal sensation on a single side of the face, like tingling or numbness. Trigeminal neuralgia, Bell’s palsy, epilepsy, multiple sclerosis, Guillain-Barre syndrome, and so on, are known to cause abnormal facial sensations in the form of tingling numbness or even pain. These have been discussed in more detail in

Tingling and Numbness in the Face and Back of the Head

Mechanisms of Cervicogenic Facial Pain

The trigeminal nerve arises from the mid-brain or brain-stem (Picture 1), which is located above the spinal cord. But the nucleus of this nerve (area from where the nerve fibers forming the nerve originate), extends from the brain-stem down to the third cervical segment of the spinal cord (C3). It is surrounded by the ganglions of the spinal nerves and is known to interact with these cells (Picture 2). This functional interaction is responsible for the to and fro referral of painful sensations from neck and face. This can even result in headache, which is referred as cervicogenic headache (1).

Picture 1: Trigeminal Nerve Origin

(Source: Wikimedia Commons)

Several receptors are responsible for perception of sensations on the face. Touch, pain, pressure, temperature, and so on, are all perceived by individual receptors present in the skin. Nerve fibers from these receptors form sensory nerves and carry the sensations from these receptors to the brain. However, due to interconnections between these nerves the sensations from a particular area reach several nerves and reach the brain by different pathways. So if a particular nerve is damaged the neighboring nerves carry the sensations from that part. That is why, if a single nerve is damaged, it only leads to partial loss of sensations rather than complete numbness.

Picture 2: Trigeminal Nucleus with spinal interconnections

These interconnections (Picture 2) lead to partial transmission of facial sensations through the cervical nerve roots. Thus, when the cervical roots are compressed the pain is partially referred to the face. This is especially true in combined neck and facial pain. They have a typical pattern, with initial neck pain, which later on involves the shoulder and facial regions. The reason for this being spatial summation, which increases the area of referred pain over time (by recruiting additional nerve cells), to involve even those areas which are least innervated by the cervical nerve fibers like the face.

The neck muscles, namely the trapezius and sternomastoid, are supplied by the accessory nerve, which is another cranial nerve arising from the brain. The nucleus of the accessory nerve lies in the upper segments of the spinal cord beside the trigeminal nucleus. Neck spasm due to trapezitis or sternomastoid involvement can also lead to facial symptoms. This is due to the interaction between the nuclei of the trigeminal nerve and the accessory nerve at the level of the mid-brain.

Cervical spine involvement in the form of prolapsed or bulging disc (slipped disc), spondylosis (arthritis), spondylolisthesis (slipped vertebra), osteoarthritis, or canal stenosis, can all lead to pressure on the cervical spinal segments, which is transmitted to the trigeminal nucleus because of the interconnections. Sometimes, in severe stenosis of the spinal canal there is direct pressure on the trigeminal nucleus, leading to facial tingling, numbness, or pain. Cervicogenic facial pain is usually unilateral, but can affect both sides too. Posture and neck movement plays a major role in the generation of this type of pain (1).

Treatment of Cervicogenic Facial Pain discusses the various treatment options that can effectively help to control this disease.

Related Articles:

References:

(1Cervicogenic Headache: A Review of Diagnostic and Treatment Strategies

About Dr Gauresh (69 Articles)
An orthopedic surgeon trained in JJ Group of Hospitals and Grant Medical College. I have worked in this field for the past 3 years and have significant clinical experience to guide students and patients on any topic in orthopedics.

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  • believerinsomething

    Interesting

  • Deta

    Is it possible for someone to also have ear ringing and blurry vision from pressure on the spinal cord?

  • Does this article reflect an accepted consensus on the origins of Trigeminal Neuralgia? I’ve been working with chronic face pain patients as a layman volunteer for nearly 20 years, and yours is the first claim I have seen of this type.

  • Hi Red. We cannot say for sure as this writer is no longer on our team. This article is 4 years old and the writer (who is a qualified orthopedic specialist) now runs his own website (www . orthoped . org). You can follow up with him. You may also want to search through ‘scholarly articles’ related to the subject on the internet as well as log in and search journal articles on the relevant medical journal websites (if you do have paid access).

  • If the writer is no longer with your team and nobody else is willing to take ownership of the article, then may I suggest respectfully that you take it down?

  • Hi Red. We will refer to matter to our medical editor based on any evidence that you provide to show the contrary. Please provide reference to medical journals and other scientific papers to justify your point. As far as we can ascertain at this point in time, some of the information was referenced from this source http://jaoa.org/article.aspx?articleid=2093083

  • Sorry that reference link again is http://jaoa.org/article.aspx?articleid=2093083

  • Probably the best reference would be the Trigeminal Neuralgia Fact Sheet from the US National Institutes for Neurological Disorder and Stroke. http://www.ninds.nih.gov/disorders/trigeminal_neuralgia/detail_trigeminal_neuralgia.htm .

    Fair disclosure: I wrote the most recent version and coordinated external review by doctors on the Medical Advisory Board of the US Trigeminal Neuralgia Association. Thus the NINDS position reflects the opinions of several medical doctors who specialize in treatment of chronic neurological face pain. I also wrote most of the Wikipedia entry on Atypical Trigeminal Neuralgia.

    Regards,
    Richard A. Lawhern, Ph.D.
    Moderator and Resident Research Analyst
    “Living With TN” — an online community within the Ben’s Friends cluster for patients with rare medical disorders.

  • Ear ringing might deserve the medical name “tinnitis”. It is commonly associated with compressions of a ganglion along the auditory nerve, by blood vessels. Blurry vision would generally be associated with other factors such as arterio-veinous malformation, or benign tumors near the optic nerve. I would suggest that you get worked up by a neurologist and have a high resolution MRI done with and without contrast agent, to eliminate such issues and develop a treatment plan.

    Regards,

  • Thank you for your response Red. We will inform our medical editor to assess this article and your response in this regard. Unfortunately we will not consider a reference to any Wikipedia material given the nature of the website and that the content can be changed by contributors. Is there any part of the Health Hype article that you take exception to?

  • I understand your reservations on Wikipedia resources, and share them to some extent myself. Where I take measured exception is with the implication that compressions or dislocations in the cervical spine may be associated with trigeminal neuralgia or trigeminal neuropathic pain (sometimes called “atypical” trigeminal neuralgia).

    I deal with and support chronic face pain patients every day, and I hear repeated stories of chiropractors and osteopaths who claim to treat chronic face pain by manipulation of the cervical spine. Results have been very spotty at best, and in some cases quite negative, with some patients experiencing increased and persistent pain after such “treatments”.

    This article was drawn to my attention by a chronic face pain patient who claimed that it validates chiropractic and osteopathic adjustment as effective for trigeminal neuralgia. It does not in fact do that. The jury is still out and there have been no double-blind trials that I’m aware of.

    The single reference in this article is to a piece in the Journal of the American Osteopathic Association. A careful reading of the reference suggests that the symptoms of “cervicogenic face pain” are distinct from those of trigeminal neuralgia, and to a lesser degree from those of trigeminal neuropathy. However, this distinction is not carried over into the article on Health Hype.

    I would suggest that a medical editor’s footnote might serve to qualify the article appropriately. “Cervicogenic face pain is medically distinct from classic Trigeminal Neuralgia and is generally treated by other means.”

  • Thank you for the feedback Red. We can see your point as readers may misconstrue the two separate entities discussed in this article. It is important to note that the first cervical nerves do have both an excitatory and inhibitory interaction with the trigeminal nerve. High frequency cervical spine stimulation is one of the modalities in refractory trigeminal neuralgia. Nevertheless, we will flag this article for our medical editor to review. Your input is greatly appreciated.

  • Cat Summers

    I disagree with Red.. This article should remain. My mother has suffered for 4 years with TN, going from doctor to doctor. All they have given her is shots of this and plenty of dope to swallow. She has a herniated disk in her neck which up till now has always been pushed aside as far as being a possible reason for this facial pain. I have found a doctor that believes as I have from the start, that this TN pain can be caused by another factor. Finally she will meet with this doctor in 2 weeks to be examined. TN is a tricky pain and I for one think every avenue should be checked. You’d be stupid not to think twice about this article…

  • Cat Summers

    Red, doctors are not always correct.. Infact I have found that if they don’t see it on an x-ray, it doesn’t exist . Times have changed, doctors do not bother to read up on many diseases anymore. They don’t even understand the drugs they shove down peoples throat, but they do understand the benefits for themselves of pushing these pills… I don’t care what you have written, or what letters you have after your name, it doesn’t make you correct, or God, which is what you asre trying to sound like. You do not own this sight, so move on.

  • Andrew Jeavons

    Hi – I live in the UK. I suffer from TN and Occipital Neuralgia, caused by osteoarthritis in the neck (which causes inflammation, which causes pressure on the nerves and so the referred pain in the face). As such, please do not remove this article, just on one person’s say so, as it very much rings true with me. Thank you.

  • Nina Craig

    i agree this site should not be removed. This is very helpful to me because I have sever facial pain due to 24/7 aggressive involunatry movement in my face. I’ve been to at least 15 specialists, including neurosurgeons, neurologists, pain management, ENT, etc… No one knows nor understand this is happening so all brushed me off. I just had an MRI of the neck and it shows budging discs at C3 to C7 and T1 and cervical canal stenosis. I didn’t even know I have neck problem because the severe 24/7 facial pain has been consuming all my energy. I’m going to book an appointment with an orthopedic surgeon so he can review my MRI to see if there’s a correlation between my facial pain and the neck issue.

  • Thanks for the vote of confidence Nina.