Facial Pain A Key Symptom of Headache and Migraine Disorders

Results published in Neurology show that approximately 10% of people with headache disorders have facial pain as a symptom of their headache. The study involved 2,912 people who had migraine, cluster headache, paroxysmal hemicrania (PH), hemicrania continua (HC), or short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT). The presence of facial pain differed amongst different headache types (Table). In addition, for migraine facial pain was the primary symptom for 41% of the 2% with facial pain. For cluster headache, of the15% with facial pain, it was a primary symptom for 31% of them. The number of people surveyed for PH (n = 20), HC (n = 42), or SUNCT (n = 15) was too small to reliably determine a percentage for whom facial pain was the primary symptom. 

In addition, 6 individuals had constant unilateral facial pain with multiple attacks per day of facial pain that lasted 10 to 30 minutes. This type of pain syndrome has not been described before, and the study authors propose the name constant unilateral facial pain with added attacks (CUFPA).

For this study, facial pain excluded eye pain, a common feature of migraine and other headaches, unless headache was excluded by the person responding (ie, they reported only pain below the orbitomeatal line, anterior to the pinnae and above the neck. 

 “Facial pain has not been well-recognized as a symptom of headache, and some people end up waiting a long time for a proper diagnosis and treatment,” said Arne May, MD, PhD, University of Hamburg. “This study shows that facial pain is not uncommon, and for many people their pain occurs mainly in the face, not the head. For a better understanding of these types of facial pain and ultimately for the development of treatments, it’s crucial that we understand more about facial pain and whether it is the same disease as the headache, but showing up in a different place, or whether they are two different syndromes.”