Head Sensitivity Map – Head Dermatomes

facial innervation

Picture 1. Sensitivity map of the head – head dermatomes
(Click to enlarge image)
(source: Wikipedia)


Sensitivity of the FACE and TOP OF THE HEAD is mediated by the right and left Trigeminal nerve (5th brain nerve), which originate from the brainstem and divide into three branches each:

  1. Ophthalmic nerve travels through the ceiling of the orbit and enters the face above the eye. It innervates the front half of the top of the head, forehead, eyebrow, upper lid, the skin on the top of the nose, cornea, eye conjunctiva, and frontal sinuses.
  2. Maxillary nerve travels across the bottom of the orbit and enters the face below the eye. It innervates the skin on cheeks, upper lip, sides of the nose, lower eyelid, a part of mucosa in the nose, paranasal sinuses, upper gum, and upper teeth.
  3. Mandibular nerve: mental branch travels along the inner side of the jawbone, enters the skin on the sides of the chin and innervates the skin of the jaw. Auriculotemporal branch innervates the skin in the front of the earlap, and temporal region.

Sensitivity of the BACK OF THE HEAD is mediated by the first three spinal nerves (cervical nerves C1-C3) .
Sensitivity of the NECK and most of the EARLAP is provided by the superficial cervical plexus composed by cervical nerves C1-C4.

What Causes the Numbness on the Head?

Head or face tingling or numbness is caused by irritation of the cervical (C1-C4) nerves, Trigeminal nerve, or parts of the spinal cord, brainstem or brain responsible for the sensitivity of the head/face.

Causes include: spinal disorders, like herniated disc, neurological diseases, like multiple sclerosis, vascular disorders, like atherosclerosis, infections, like meningitis, poisoning, epilepsy, tumors, injuries, metabolic changes, like hypokalemia, and other causes listed below.

NEUROLOGICAL DISORDERS

Disorders primarily affecting nervous tissue include:

Herpes Zoster (Shingles)

Herpes zoster (shingles) is a reactivation of a chicken pox virus in the nerve roots of Trigeminal or cervical nerves at any time (months, years) after chickenpox infection, resulting in:

  • Tingling on the one side of the face, scalp or trunk, followed by a band of red patches and painful blisters that crust over and fall off in 2-3 weeks. Sometimes there is no rash but only tingling sensation.
  • Fever, headache, vision, hearing or taste problems may appear.

Herpes zoster can be treated by acyclovir or famcyclovir.

Post-herpetic Neuralgia

Post herpetic neuralgia is a complication of Herpes zoster reactivation, mostly seen in patients over 50 years of age. Facial tingling, numbness or pain may last several months or years.

Lyme Disease

Lyme disease is a tick-borne infection caused by bacterium Borrelia burgdorferi. Symptoms include:

  • Circular red rash with a pale centre appearing few days or weeks after a tick bite (rash lasts few weeks). Fever and fatigue are sometimes present.
  • Months or years after the tick bite (there is no rash at that time), tingling, paralysis of facial muscles, vision disturbance, problems with memory, migratory joint pain (especially in knees) and heart problems can appear.

Trigeminal Neuralgia

Trigeminal neuralgia (tic douloureux) is a chronic nerve disorder of unknown origin, mostly affecting adults, and causing:

  • Sudden severe shock-like (or mild) facial pain, lasting from few seconds to two minutes, triggered by tooth brushing, shaving, chewing, speaking, laughing, or even a slight breeze. Tingling and numbness as a warning symptom before the pain attack. Symptoms often progress in frequency and severity.

Trigeminal Neurophatic Pain

Trigeminal neuropathic pain can appear as a complication of trauma, dental procedure, surgery, or disease, like diabetes or stroke. Symptoms, usually on one side of the face, include:

  • Constant, dull, burning pain
  • Numbness and tingling

Trigeminal Deafferentation

Pain in trigeminal deafferentation (interruption of sensory nerve fibers) results from nerve damage, usually during treatment of trigeminal neuralgia (alcohol injections, surgery). Main symptom is:

  • Continuous burning numbness

Anesthesia Dolorosa

Anesthesia dolorosa is usually a complication of treatment of trigeminal neuralgia. Symptoms:

  • Facial numbness and constant or stabbing pain occurring at the same skin area

Treatment of Trigeminal neuralgia and neuropathies , complementary treatment

Multiple Sclerosis

Multiple sclerosis (MS) is, as believed, an autoimmune disease affecting the brain, brainstem or spinal cord. Symptoms usually appear between 20-40 years of age and include:

  • Blurred vision, or even blindness, usually at one eye at the time
  • Muscle weakness or paralysis, usually on one side of the body
  • Unusual sensations or pain anywhere in the body
  • Difficulty speech, hearing loss, dizziness, impaired balance, difficulty with concentration
  • Fatigue, depression

Transverse myelitis and acute flares of multiple sclerosis are often treated with steroids.

Epilepsy

In epilepsy, abnormal electrical activity in the brain cells can cause episodes of:

  • Tingling, numbness, changed taste or smell, strange emotions or behavior
  • Convulsions, muscle spasms, and, sometimes, loss of consciousness.

Guillain-Barre syndrome

In a rare Guillain-Barré syndrome, immune system, usually some days or weeks after respiratory or food poisoning, attacks peripheral nerves. Symptoms can develop fully in few hours or few weeks, rarely extend over 2 months and may include:

  • Muscular weakness and numbness starting in the feet and progressing to the upper trunk and head; sometimes symptoms start in the hands or face and proceed toward the legs
  • Difficulty with bladder and bowel control
  • Severe back pain
  • Slow heart rate
  • Difficulty with eye and facial movements, speaking, chewing or swallowing (6)
  • Difficulty breathing (only in severe cases)
  • Consciousness is not affected

Tabes Dorsalis

Syphilitic myelopathy (Tabes dorsalis) is a rare complication of untreated syphilis. Symptoms:

  • Abnormal sensations (“lightning pains”)
  • Muscle weakness, loss of reflexes
  • Loss of coordination, difficulty walking, wide-based gait
  • Psychiatric illness

PSYCHOLOGICAL DISORDERS

Anxiety and Panic Attack

Symptoms in anxiety and panic attack include:

  • Feeling of fear and tightness, faintness
  • Trembling
  • Rapid heart rate, shortness of breath, hyperventilation, sweating, hot flashes, chills
  • Tingling or numbness in hands, arms, feet, legs, face, toungue, mouth, lips or other body parts

FOOD ALLERGIES, FISH/SHELLFISH POISONING

Food allergies can cause tingling lips, throat and skin itch, and swollen face.

Ciguatera poisoning after eating big tropical fish, scombroid poisoning with spoiled fish, and paralytic shellfish poisoning can cause tingling, skin rash and diarrhea.

CIRCULATORY DISORDERS

Stroke and Transitional Ischemic Attack (TIA)

Stroke is a damage of a part of the brain, occurring after a blockage or break of the brain artery due to atherosclerosis, thrombosis or rupture of an arterial aneurysm. Transient ischemic attack (TIA) or “mini stroke” occurs when a blood supply is only briefly interrupted; symptoms appear suddenly and may disappear within an hour (in TIA always within 24 hours) and include:

  • Numbness or weakness of the face, arm, or leg, usually on one side of the body
  • Confusion, trouble speaking, swallowing, seeing
  • Trouble walking, dizziness
  • Severe headache.

Symptoms in the stroke may be permanent, but can often improve within weeks/months with proper rehabilitation.

Vertebrobasilar Circulatory Disorders

In vertebrobasilar circulatory disorders, blood supply to the back of the brain, little brain (cerebellum), and brainstem is disrupted due to blocked basilar or vertebral arteries. Characteristic symptoms are:

  • Complete or partial vision loss, double vision
  • Vertigo, problems with balance
  • Numbness and tingling of the head
  • Symptoms resembling stroke (see above)

Angina Pectoris

Angina pectoris (Latin angina = tightness, pectus= chest) is a symptom of inadequately oxygenated heart, mostly due to narrowed coronary arteries (that supply the heart), rarely appearing before 30 years of age . Symptoms include:

  • Sharp or dull pain behind the breast-bone, triggered by effort, strong emotions, cold, heavy meal, or other stress; lasting from few moments to 10 minutes (up to 30 minutes in severe cases). Pain or numbness my radiate to the jaw, left shoulder, arm, or hand
  • Dizziness, sweating, nausea, shortness of breath

Vasculitis

Head tingling and numbness can result from an impaired blood supply to the nerves caused by vasculitis - inflammation of small to medium sized arteries: temporal arteritis (giant cell arteritis), Wegener’s granulomatosis, necrotizing vasculitis, polyarteritis nodosa, posterior inferior cerebellar artery syndrome , thoracic outlet syndrome, vasculitis caused by colagenoses, and so on.

INJURIES

Head or Spinal Cord Injury

Cuts, punctures, bruises or broken head/facial bones can affect nerves and thus causes numbness or tingling. Dislocated jaw may cause pain or numbness in temporal and jaw area – temporomandibular (TMP) pain.

Spinal cord injuries of the upper cervical (neck) spine (above the C4 level) may result in back of the head numbness. Motility and sensitivity of other parts of the body will be also likely affected.

SPINAL DISORDERS

The following disorders affecting cervical spine above C4 level can cause tingling or numbness on the back of the head:

  • Spinal arthritis (spondylitis)
  • Degenerative disc disease (DDD)
  • Bulging or herniated disc
  • Osteoporosis

TUMOR, ABSCESS

A tumor or abscess (collection of pus after infection) in the brain, orbit, ear, nose, paranasal sinuses, mouth, parotid glands, muscles or skin, skull, vertebra or spinal cord can directly press on the nerve tissue or infiltrate it, thus causing unusual sensations or pain in the face or back of the head.

Paraneoplastic Syndrome

Substances, like serotonin, secreted by various tumors (especially lung cancer and carcinoid) can cause paresthesia in any body part.

METABOLIC DISORDERS

Metabolic disorders that may result in tingling anywhere in the body:

  • Abnormal blood levels of calcium (hypocalcemia, hypercalcemia), potassium (hypokalemia, hyperkalemia), magnesium, sodium, vitamin B1 (thiamine), B6, or B12, thyroxin, aldosterone
  • Hypoglycemia (low blood sugar), commonly occuring in insulin dependent diabetics, chronic alcoholics, in prolonged starvation, heavy exercise, dumping syndrome
  • Uremia (in chronic kidney failure)
  • Amyloidosis
  • Porphyria - inherited or acquired disorder of heme (part of hemoglobin) synthesis
  • Hypothyroidism, hypoparathyroidism, hypoaldosteronism (Conn syndrome)
  • Menopause

MEDICATIONS, DRUGS and TOXINS

  • Medications: anti-convulsant drugs, lomotil, amiodarone, colistimethate, digoxin, dimercaprol, mefloquine, riluzole, tetrodotoxin, thallium, topiramate, HIV medications, metronidazole, overdose of lidocain or vit B6, SSRI withdrawal
  • Radiation therapy, chemotherapy
  • Alcohol causes alcohol neuropathy (chronic paresthesia), but it can be directly toxic to nerves (acute paresthesia). Alcohol withdrawal after long term drinking can cause sensation of “crawling bugs”.
  • Tobacco
  • Poisoning: heavy metals (arsenic, lead, mercury), nitrous oxide, ciguatera poisoning with tropical fish, snake bites, carbon monoxide

OTHER CAUSES OF HEAD TINGLING AND NUMBNESS

  • Migraine. Symptoms: one sided head pain, nausea, vision problems
  • Infections: AIDS, leprosy, Herpes simplex, rabies, canker sores, arbovirus
  • Connective tissue and autoimmune diseases: rheumatoid arthritis, systemic lupus erythematosus (SLE), Sjögren’s syndrome (dryness in the tear ducts, salivary glands, and other glands), pernicious anemia
  • Blood disorders: thrombosis, polycythemia, thrombocytosis, leukemia
  • Bones and joints disorders: arthritis, osteomalacia
  • Fibromyalgia
  • Nutrient deficiency: vit B1 (beriberi), vit B5 and B12 deficiency
  • Hereditary diseases: Refsum syndrome, Fabry disease, Charcot-Marie-Tooth disease (wasting of the leg muscles, resulting in malformation of the foot), porphyria (increased production of porphyrins), Denny-Brown’s syndrome (disorder of the nerve root), ataxia-teleangiectasia
  • Immune deficiency

Diagnosis of the Cause of Head Paresthesia

1. Revealing the exact history of your symptoms to your doctor is essential to get a diagnosis:

  • Time course: When and how did symptoms start (injury, unconsciousness, sudden head pain…), are they long lasting or recent, constant or change with time
  • Location: exact areas affected, one/both sided, non/symetrical
  • Other head related symptoms: pain, vision, hearing, smell, taste, temperature sense, or balance problems. Problems with speech, eating, or moving the head or limbs (weakness, cramping, paralysis). General symptoms: nausea, fever.
  • History of trauma, starvation, diabetes, alcohol abuse, cancer, or collagen vascular disease
  • Family history: paresthesia in relatives

2. Neurological examination of the whole body, performed by a neurologist is required.

3. The following tests may be needed:

  • Blood tests: CBC, electrolytes, calcium, magnesium, TSH, glucose, BUN/creatinine, hemoglobin A1C, ESR, vitamin B12, thiamine level, and chest X-ray
    –Additional tests may be indicated (lead level, SPEP and UPEP to rule out paraproteinemia, Lyme titers)
  • Electromyography (EMG) may be used to differentiate neuropathic versus myopathic causes of muscle atrophy
  • Nerve conduction studies
  • Nerve biopsy (rarely needed)

Treatment of Head/Facial Numbness

Treatment posibilities of head/facial tingling include:

  • Treating the underlying cause
  • Coping with stress, stopping drinking or abusing drugs
  • Supplements as vitamin B complex, calcium, magnesium (only according to blood tests)
  • Anti-inflammatory drugs (NSAIDS or steroids – epidural in severe cases)
  • Analgesics or antidepressants

Related Articles:

References:

  1. Sensory innervation of the head, trigeminal nerve (bartleby.com)
  2. Causes , Diagnosis and Treatment of Paresthesia (wrongdiagnosis.com)
  3. Causes , Diagnosis and Treatment of Paresthesia (wrongdiagnosis.com)
  4. Diagnosis of face Numbness (wrongdiagnosis.com)
  5. Guillain Barre syndrome Symptoms (mayoclinic.com)

Article reviewed by Dr. Greg. Last updated on August 3, 2013