A migraine is a complex neurological disorder involving various symptoms beyond head pain. Migraines can definitively cause facial pain. This symptom is a form of referred pain that can be intense and debilitating. Understanding this connection requires looking into the underlying nerve pathways that process sensation in the face and head.
The Trigeminal Connection
The mechanism linking migraines to facial pain centers on the trigeminal nerve (Cranial Nerve V), the largest of the cranial nerves. This nerve transmits nearly all sensory information, including touch, temperature, and pain, from the face and head to the brain. The trigeminal system includes three main branches covering the forehead and eyes, the cheeks, and the jaw and lower face.
During a migraine attack, trigeminovascular system activation occurs. This involves releasing specific chemicals, notably calcitonin gene-related peptide (CGRP), which acts as a powerful pain signal and inflammatory agent. When the trigeminal nerve pathway is activated, it sends pain signals that the brain “misinterprets” as originating from the facial areas it innervates, even if the primary source is elsewhere.
The nervous system can become over-sensitized through central sensitization, contributing to the intensity and chronicity of migraine pain. This hypersensitivity means minor stimuli can trigger a pain response, causing the face to become tender or painful during an attack. The pain is a neurological symptom resulting from the activation and inflammation of the nerve network supplying the face.
Recognizing Specific Pain Patterns
Migraine-related facial pain frequently mimics other common medical conditions, leading to diagnostic confusion. A common presentation is pain and pressure localized around the forehead, eyes, and mid-face, closely resembling a sinus infection. Patients often describe this as deep pressure or fullness behind the eyes or in the cheekbones, sometimes accompanied by nasal congestion or a runny nose.
The pain can radiate downward into the lower two-thirds of the face, affecting the jaw, gums, and teeth, sometimes called orofacial migraine. This dental or jaw pain can be intense, throbbing, or aching, and may be mistaken for a toothache or temporomandibular joint (TMJ) disorder. Another pattern is intense orbital or retro-orbital pain, centered around or directly behind the eye.
This type of pain is often unilateral, meaning it occurs on only one side of the face, mirroring the typical one-sided nature of many migraines. This facial pain is usually sustained, fluctuating in intensity over the migraine episode. It is typically accompanied by classic migraine symptoms like sensitivity to light or sound. The presence of these combined symptoms strongly indicates the facial discomfort is migraine-related.
Differentiating Causes of Facial Pain
Distinguishing migraine-related facial pain from other causes is crucial for appropriate treatment. When pain is concentrated in the mid-face, it is often confused with sinusitis. True sinus pain from a bacterial infection typically involves thick, discolored nasal discharge and often a fever, which are absent in migraine. Migraine pain, even when felt as pressure, is usually pulsatile or throbbing and lacks the infectious markers of acute rhinosinusitis.
It is important to differentiate migraine facial pain from trigeminal neuralgia, an entirely different neurological condition. Trigeminal neuralgia causes brief, sudden bursts of excruciating, electric shock-like pain, typically triggered by light touch, chewing, or talking. In contrast, migraine facial pain is a sustained, deep ache or throbbing discomfort that lasts for hours, not seconds.
Pain that mimics a TMJ disorder can be distinguished by its triggers. TMJ-related pain is often worsened by specific jaw movements, such as chewing or wide opening of the mouth. Migraine-related facial pain is an internal nerve pain that does not usually intensify with mechanical jaw function. The presence of nausea, vomiting, or heightened sensitivity to light and sound alongside the facial pain are the strongest diagnostic clues pointing toward a migraine.
Targeted Treatment Strategies
Treatment for migraine-related facial pain is the same as the treatment for the underlying migraine attack. The goal is to address the activation of the trigeminal system and the associated inflammatory process. Acute treatments, such as triptans, work by targeting serotonin receptors to constrict blood vessels and block pain signals along the trigeminal pathway.
Newer acute medications, known as CGRP receptor antagonists (gepants), specifically block the action of the pain-signaling CGRP molecule, which is highly involved in trigeminal pain transmission. These targeted therapies stop the migraine cascade, alleviating both the headache and the referred facial pain symptoms. Preventive treatments, including blood pressure medications, anti-seizure drugs, and monthly CGRP monoclonal antibodies, help desensitize the overactive trigeminal system, reducing attack frequency.
For non-pharmacological relief, applying a cold pack to the face or neck can help numb the area and reduce local inflammation. Devices using non-invasive neuromodulation, such as those stimulating the vagus or trigeminal nerves, can be utilized for both acute and preventive treatment by altering how nerves communicate with the brain. These strategies aim to calm the hypersensitive nervous system responsible for projecting the pain into the facial region.