By Edmund Messina, MD, Medical Director of the Michigan Headache Clinic in East Lansing, Michigan While headaches are typically thought to be located around the forehead or back of the head, there are types of headache that strike the face itself. Trigeminal neuralgia is a form of severe facial pain in which patients experience brief volleys of very painful electric shock sensations triggered by mild touch to the face or mouth. This touch can be from washing, shaving, eating, brushing the teeth or even talking. The trigger zones are particularly sensitive in the area between the nose and mouth or on the chin.

Surgery may be a better option for individuals with trigeminal neuralgia than second-line drugs, according to new American Academy of Neurology guidelines. Trigeminal neuralgia (also known as tic douloureux) generally strikes people over age 50. The pain is an intense, burning sensation on one side of the face, often set off by touch, chewing, laughing, talking or even a cold breeze. The intermittent jabs of pain last for approximately 30 seconds, followed by a few pain-free moments, and then another group of painful jabs, which may reoccur for a few hours at a time. The attacks can go on for weeks or months.

By David M. Biondi, D.O. Director, Headache Management Program, Spaulding Rehabilitation Hospital and Instructor in Neurology, Harvard Medical School THE CASE James is a 65-year-old man who woke one day with severe pain on the right side of his face. The pain, which seemed to tear through his face like a lightning bolt, lasted only a few seconds, but then returned. For weeks, he had been experiencing dozens of these excruciating electrical shock-like attacks. James could no longer shave the right side of his face, brush his teeth, chew foods or talk for any length of time without triggering the repeated jolts of pain. He could not even tolerate a light breeze blowing across his face. James' dentist could find no problems with his teeth or jaw and over-the-counter pain relievers provided no benefit.

Chronic facial pain can be very confusing both to the patient and healthcare provider. This can be direct pain - involving nerves that supply the face or indirect (referred) pain from other structures in the head such as blood vessels. The pain may be related...