 Hi, my name is Dr. Nishant Yagnik. I am the head of Neurosurgery at Manipal Hospital Gulgaon and today I will be talking to you about Facial pain pain that people feel in the face and in the forehead Now this is different from headaches, which is what a lot of people commonly have and we've done talks about headaches before But facial pain is a very special kind of pain with some very specific diagnosis and they can be Terribly debilitating. They can affect your quality of life so badly that facial pain used to be About maybe 50 60 years ago one of the commonest causes of suicide Now when I talk about facial pain I mean pain in these three regions of the face You see if you divide the face into three places One is up to the angle of the eye then the angle of the mouth and then up till the lower part of your job You get three regions and this we name as one two and three All three regions are supplied in terms of the sensory supply How they feel by a single nerve that divides into three branches and this is called the trigeminal nerve It is one of the largest nerves that come out comes out of the brain And it is also one of the most notorious for having Degeneration or deterioration or causing facial pain Now facial pain has multiple diagnosis But one of the most important diagnosis is trigeminal neuralgia, which means the same nerve with three branches Can lead to people feeling terrible Lansinating which means a shock-like sensation Pain for something from a few seconds to a few minutes multiple times a day So every time you brush every time you chew your food or even if there is a breeze with cold air in it Patients can feel terrible wincing pain Now trigeminal neuralgia by itself is a very large topic But what I my aim here is to try to tell you that if you have a pain like this you need to see A doctor a particularly a neurospecialist Because trigeminal neuralgia is well controllable in some cases Curable and this debilitation this difficulty is not something that you need to face Your whole life without treatment Another kind of a facial pain. I wouldn't say pain. It's more like a spasm. It's called hemifacial spasm Hemifacial in hemifacial spasm. They can be a twitching of one side of the face Now the twitching is involuntary. You can't help it Sometimes it can even happen when you're sleeping and people notice it instead of you Now what happens in this condition is it twitches so badly and so frequently it continuously twitches That not only is it socially very difficult to talk about it with people It is also something that causes a lot of fatigue on your face Your face will get totally cramped by the end of the day and you still can't help the twitching. It is completely automatic Another kind of facial pain is a neurologic pain that is not trigeminal neuralgia Now these kind of pains they occur because of smaller nerves that can go into Go towards the forehead now this includes nerves they're affected by Your by your blood vessels and the thickening of your blood vessels with age which also happens In your heart and the rest of your body Some of the examples of this is called giant temporal arthritis Which causes a severe temporal pain this area is called the temporal region over here And they can also be referred pain on the face referred pain is that the problem is somewhere else But you're feeling the pain on the face and this can happen because of head injuries Sometimes the head injury is not so severe and most doctors will tell you that you know Your brain is not affected your skull is not affected But you will continue to feel difficult and debilitating pain that seemingly no one can explain Now the treatment for these kind of pain syndromes is usually The first thing that you need to do is have a the accurate and the right diagnosis And this is where a lot of people they get stuck Because tests often come out absolutely normal And the diagnosis of these conditions is often clinical which means that The doctor has to understand the kind of pain that you have the regions of the pain And then try to make a diagnosis of where that pain is actually originating There are medicines that can stop pain anywhere. We know we're called painkillers and most people they take painkillers at home But painkillers by themselves when taken continuously for a long period can affect your kidneys They can affect your liver. They can affect your hearing. They can affect your vision And so a time comes when you need specific medications or treatments for the particular region that is causing your pain This includes injection therapies which are excellent ways of pain control with very little very few side effects This includes injections in various areas Pin pointing where your pain Occurs another kind of injection is Botox injections especially for hemifacial spasm Which actually reduces the strain on the muscles and on the nerves That is being caused by this facial pain and the problems that it causes A third treatment is radiofrequency ablation or alcohol ablation Where we destroy part of the nerve so that the pain carrying capacity of the nerve is specifically counted And a final treatment is with surgery. Now surgery is done in only those cases where everything else has failed Usually in only about one to two percent of patients of facial pain Surgery usually is highly effective. Everything has its risks and complications and therefore we if the patient gets to a point Where you know the quality of life is so bad despite medications and the medicines and the treatments themselves are becoming so dangerous That surgery becomes the safest option And although complications occur they are Very very far and you know few So what are the the conclusion I would like you to take from facial pain is number one Recognize that your facial pain might not be something simple. It might be part of a more complex problem number two When this happens Don't just keep taking painkillers because if you're taking painkillers for weeks on end The painkillers themselves are going to be more dangerous for you than the pain The treatment can become worse than the problem number three You often need very specific neuro based Regenerative and controlling medications to treat many forms of facial pain and number four Excellent treatments exist for facial pain including injection therapies, which is done in conscious patients and Surgery which we do under anesthesia Which will make you believe that you know, I don't know why I was which make you say I don't know why I was taking painkillers for so long. I should have just gone with this first so Do definitely see a doctor if you have these kind of pain syndromes and there is definitely hope at the end of the tunnel Thank you