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4 facial pains and what they mean

Facial pain, say experts, point to conditions that affect varied parts of the body

Twenty-three-year-old IT engineer, Dharni Gurnani, made peace with recurrent headaches she had been battling for 10 years. She'd avoid brightly-lit and air-conditioned rooms, and when the pain got unbearable, she'd reach out to a painkiller. "That would sort me out for a few days, but it would be back in three days," she says.

A visit this year to pain specialist Dr Raashi Khatri-Panjabi, however, led to the realisation that the source of the headache was in the muscles of her neck. Gurnani's posture was the culprit. She was diagnosed with the classic turtlehead posture-forward head and sloping shoulders.

The doctor, who says she receives 50 new cases a week at her clinics in Juhu and Colaba, says pain in the orofacial region (face, mouth, nose, ears, eyes, neck, and head) is usually the result of a problem somewhere far from it. Dr Khatri-Panjabi says, "Patients often complain of chronic headaches at the top of the head along with stiffness at the base of the skull that radiates to the tips of the fingers. Often, this is wrongly attributed to stress."

4 facial pains and what they could point to

A. Symptom: Deep, dull headache
Condition: Neck muscle spasms
Caused by: Whiplash (neck injury), poor posture and long hours at computer, physical stress

How does a spasm in the neck muscle play out as a headache, like in Gurnani's case? Medically termed as myofascial pain, this is common and characterised by discrete tender areas or trigger points. The spasm may occur in the centre of the neck muscle but it can play itself out at any point along the length and width of the muscle, like the top of the head. Therefore, a muscle spasm in the neck can show up as a debilitating headache, says Dr Khatri-Panjabi, founder of the Center for Orofacial Pain. "These deep, dull headaches are often referred to as cervical headaches and more commonly as 'tension headaches'. But the tension does not refer to psychological stress but actual tensile forces acting on the muscle, she clarifies.

B. Symptom: Ache at base of skull, neck and face
Condition: Rounded shoulders (slouching)
Caused by: Poor sleeping posture (wrong pillow) and over-exercising upper body at the gym

The shoulder and the head share muscles that pass through the neck. Physiotherapist Poonam Bajaj explains: "The internally rotated (forward rotated) shoulders increase the compression on the collar bone and the attached muscles. There is a shortening of the pectoral (chest) and scapular (shoulder blade) muscles. As the head and neck are brought forward, the patient is forced to extend the back of the neck to keep the eyes horizontal, resulting in overactivity of the muscles at the base of the skull." When these muscles are tightened, the head and shoulders are pulled forward leading to Forward Head Posture and rounded or slouching shoulders. The constant effort to bring the head back into its normal position is what causes pain at the base of the skull, neck and face.

C. Symptom: Electric shock-like pain in cheeks, near nose and jaw
Condition: Trigeminal Neuralgia (TN)
Caused by: Blood vessel pressing on a nerve inside the skull, multiple sclerosis

This nerve disorder got famous when Salman Khan was diagnosed with it in 2011. It's an impingement on a nerve branch in the spinal cord or brain stem that shows up as sharp, shooting, burning pain around the nose and above the lips. Neuro-surgeon Dr Keki Turel, says, "The trigeminal nerve has three divisions that subserve sensations over 1) forehead, 2) cheeks, and 3) lower jaw. Though predominantly a sensory nerve, it also has a motor division that supplies the muscles that aid chewing. The nerve enters the brain stem in the trigeminal nucleus and from there it has projections higher up in the brain." All nerves are covered by a sheet called myelin, which works like an insulation around a wire, preventing leakage of current. The trigeminal nerve is myelinated, except in the last few millimeters where it enters the brain stem — here it remains naked, and ultrasensitive. It is this unmyelinated area where throbbing of a blood vessel makes it excitable, resulting in severe pain. This intermittent pain is triggered by even the slightest external stimulation — touch, brushing teeth, chewing, or even a draft of wind. "The pain is so severe, it can drive a person to contemplate suicide, says Dr Turel.

D. Symptom: Ache in temples, ear pain, facial soreness, limited range of motion of mouth, clicking and joint noise
Condition: Jaw disorder
Caused by: Grinding of teeth in sleep, cradling phone between neck and shoulder, biting nails, clenching teeth during a task that requires focus

Temporomandibular Joint (TMJ) or the jaw joint is located in front of both ears and connects the lower jaw with the skull. The TMJ along with the muscles of mastication allow you to chew, yawn, shout, whistle, talk and sing. "Considering it is the most used joint in the body, a TMJ dysfunction can be severely debilitating," says Dr Khatri-Panjabi. "TMJ disorders can be felt as tooth pain even in the absence of dental pathology and can contribute to snoring and sleep apnoea," she adds.


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