Facial Pain: Differential Diagnosis
Written 1st June 2020 - Last Update 20th July 2026
Facial Pain: Differential Diagnosis
| Facial pain type | Pain characteristics |
|---|---|
| Rhinosinusitis (acute/chronic) | Frontal, maxillary or periorbital pressure/throbbing; sinuses tender to palpate; sense of blockage, nasal/postnasal discharge; worse bending forward. |
| Trigeminal neuralgia | Recurrent, unilateral, shock-like pain in one or more trigeminal divisions (especially V2/V3); triggered by simple stimuli (touch, eating, brushing teeth, speaking, cold wind); attacks last seconds–minutes with a brief refractory period; moderate persistent background pain may accompany. Mainly women 40–70 years. May reflect neurovascular compression or an MS plaque. |
| Glossopharyngeal neuralgia | Severe, transient, unilateral stabbing pain over the 9th cranial nerve distribution (ear, tongue base, tonsillar fossa, below jaw angle); provoked by swallowing (especially cold liquids), talking, coughing, chewing, yawning. Onset usually >60 years. ~2% lose consciousness with an attack (probable cardiac arrhythmia). |
| Greater occipital neuralgia | Shooting/stabbing pain over the occipital region (greater/lesser occipital nerve territory), typically unilateral, may radiate to the ipsilateral fronto-orbital region. Pressure over the nerve site often evokes pain; allodynia/dysaesthesia over the posterior scalp may occur. |
| Postherpetic trigeminal neuropathy | Unilateral head/facial pain persisting or recurring ≥3 months in a trigeminal branch distribution; variable sensory change; history of acute VZV reactivation in the affected region. |
| Eye/orbital facial pain or headache | Localised to the orbit, or associated with eye signs. |
| Dental pain | Usually localised to the tooth/face; can rarely cause generalised headache. Infection or traumatic irritation around a tooth. |
| TMJ dysfunction | Pain from TMJ or chewing-muscle pathology; aggravated by active/passive jaw movement or pressure over affected structures. |
| Atypical (persistent idiopathic) facial pain | Persistent, poorly localised facial/oral pain recurring daily >2h for >3 months; dull/aching/nagging (may have sharp exacerbations); doesn’t follow a peripheral nerve distribution; may start after minor trauma/surgery but persists after healing, with no neurological deficit or dental pathology; distribution can spread over time. |