Pain on one side of the face has several possible causes, ranging from a sinus infection or dental problem to nerve conditions like trigeminal neuralgia. The location, quality, and timing of the pain are the biggest clues to what’s behind it. Here’s a breakdown of the most common reasons your right side might hurt and what to look for with each one.
Sinus Infection
The maxillary sinuses sit directly behind your cheekbones, and when one becomes inflamed or infected, the pain tends to concentrate on that side of your face. Sinusitis is one of the most common reasons for one-sided facial pain, and it comes with a recognizable set of symptoms: pressure or fullness across the cheek, nasal congestion, thick nasal discharge, and pain that gets worse when you bend forward. You may also notice what feels like a toothache across several upper teeth on the affected side, since the roots of those teeth sit very close to the sinus floor.
Acute sinusitis usually resolves within about two weeks and often follows a cold or upper respiratory infection. Chronic sinusitis lasts longer and tends to feel more like persistent facial pressure, fatigue, and a sore throat rather than sharp pain. When imaging shows that only one maxillary sinus is blocked, the cause is often dental in origin, such as an infected tooth root pushing bacteria into the sinus cavity.
TMJ Disorders
The temporomandibular joints connect your jawbone to your skull on each side, and problems with these joints are a frequent source of one-sided facial pain. TMJ disorders can cause aching in the jaw, pain around the ear, difficulty chewing, and a feeling that the joint locks or clicks when you open your mouth. The pain sometimes radiates into the temple, eye, neck, or teeth on the same side, which can make it tricky to pinpoint.
Common triggers include clenching or grinding your teeth (especially during sleep), jaw injuries, arthritis in the joint, or habitual chewing on one side. If you notice that the pain is worst in the morning or flares up after eating chewy foods, a TMJ issue is a strong possibility.
Dental Problems
A tooth abscess, cracked tooth, or impacted wisdom tooth can send pain radiating well beyond the tooth itself. A dental abscess produces severe, constant, throbbing pain that can spread into the jawbone, neck, or ear on the affected side. There may also be visible swelling in the cheek, sensitivity to hot or cold, and sometimes a foul taste if the abscess drains into the mouth.
Dental pain is sometimes hard to distinguish from sinus pain because the upper back teeth and maxillary sinus share such close real estate. One useful difference: dental pain usually centers on a specific tooth and worsens when you bite down, while sinus pain spreads across the cheek and responds to pressure changes like bending over.
Trigeminal Neuralgia
Trigeminal neuralgia is one of the most intense pain conditions known. It affects the trigeminal nerve, which carries sensation from your face to your brain, and it almost always strikes one side. The pain is sudden, severe, and often described as an electric shock that lasts a few seconds to a couple of minutes. Episodes can repeat throughout the day and tend to get more frequent and intense over time, sometimes with pain-free periods in between.
What makes trigeminal neuralgia distinctive is its triggers. Everyday actions like touching your face, chewing, speaking, brushing your teeth, shaving, or even feeling a light breeze can set off an attack. Some people also experience facial spasms along with the pain. The condition is more common after age 50 and is typically caused by a blood vessel pressing on the trigeminal nerve near the brainstem.
Salivary Gland Infection or Stone
Your parotid glands, the largest salivary glands, sit just in front of each ear and extend down the side of the face. When a salivary stone blocks the duct or an infection develops (a condition called sialadenitis), you can get noticeable swelling and tenderness on one side of the face, particularly in the cheek and neck area. Pain typically worsens while eating, since that’s when the gland tries to release saliva and can’t. You may also notice a dry mouth, fever, or redness over the swollen area.
Shingles and Postherpetic Neuralgia
If you had chickenpox as a child, the virus remains dormant in your nerve cells and can reactivate decades later as shingles. When it affects a branch of the trigeminal nerve, it causes burning or stabbing pain on one side of the face, followed two to three days later by a cluster of fluid-filled blisters confined to that same area. The blisters typically crust over within seven to ten days, though they can take a month or more to fully heal. If shingles appears inside the mouth instead of on the skin, the blisters won’t crust because of the moist environment.
In some cases, pain persists in the same area long after the rash has cleared. This is called postherpetic neuralgia, and it’s more common in older adults and those with weakened immune systems. The lingering pain can range from a constant deep ache to sharp, intermittent stabs.
Giant Cell Arteritis
For anyone over 50 experiencing a new type of facial or head pain, giant cell arteritis (also called temporal arteritis) deserves attention. This inflammatory condition affects the blood vessels in the temples and scalp, and it’s most common between ages 70 and 80. The hallmark symptoms are a throbbing headache in one or both temples, scalp tenderness, and jaw pain that comes on during chewing or talking, sometimes called jaw claudication. Early on, the pain may seem to come from the teeth, jaw, ear, or cheekbone before the full picture develops.
Giant cell arteritis is considered an emergency because it can lead to permanent vision loss if untreated. Visual symptoms such as temporary loss of vision, double vision, or blurriness develop in a significant number of cases, sometimes months after the headaches begin. A blood test showing elevated inflammation markers and, in some cases, a biopsy of the temporal artery confirm the diagnosis.
Persistent Idiopathic Facial Pain
Sometimes one-sided facial pain doesn’t fit neatly into any of the categories above. Persistent idiopathic facial pain (previously called atypical facial pain) produces a deep, aching, poorly localized pain that can last for hours or be near-constant. Unlike trigeminal neuralgia, it isn’t triggered by touch and doesn’t come in sharp, brief bursts. Diagnosing it requires ruling out other causes first, which can be a frustrating process. It’s thought to involve changes in how pain signals are processed rather than a clear structural problem.
Signs That Need Urgent Attention
Most causes of one-sided facial pain are manageable, but certain combinations of symptoms point to something more serious. Seek immediate medical evaluation if your facial pain is accompanied by any of the following: sudden vision changes or vision loss, a new severe headache (especially if you’re over 50), high fever with a stiff neck or rash, facial drooping or weakness, or a rapidly accelerating pattern of pain that keeps getting worse over days. These can signal conditions like giant cell arteritis, an aneurysm, or a spreading infection that require prompt treatment.
How the Cause Is Identified
Because so many conditions can cause right-sided facial pain, the diagnostic approach depends on your specific symptoms. Dental X-rays or cone beam CT scans are used when a tooth or jaw problem is suspected. Standard CT or MRI scans help evaluate the sinuses, rule out tumors, and look for blood vessels compressing the trigeminal nerve. Ultrasound can assess the salivary glands for stones or swelling. Blood tests are important when giant cell arteritis or an infection is on the table. The key is matching the imaging or test to the most likely cause based on where the pain is, how it behaves, and what else is going on.