COVID-19 can cause facial pain through several distinct routes, from straightforward sinus congestion to direct viral irritation of the nerves that supply sensation to the face. In one longitudinal study, roughly three-quarters of COVID-19 patients reported headache during acute illness, and about half met criteria for acute rhinosinusitis, a condition that commonly radiates pain across the cheeks, forehead, and around the eyes. But sinus pressure is only part of the picture. The virus has been linked to trigeminal neuralgia, jaw-joint disorders, burning sensations in the mouth, and, in rare severe cases, a fungal infection that destroys facial tissue. Understanding which type of face pain you are dealing with matters because the causes, timelines, and treatments differ considerably.
Sinus Congestion and the Most Common Type of COVID Face Pain
The most familiar form of facial pain during a COVID-19 infection feels a lot like a bad sinus infection, because in many cases that is exactly what it is. When the virus inflames the nasal and sinus lining, fluid and swelling build up in the paranasal sinuses, creating the deep, pressure-like ache around the nose, cheeks, and forehead that most people recognize. A study following COVID-19 patients over time found that headache occurred in 72% at the initial visit and was strongly tied to rhinosinusitis symptoms, with the odds of headache roughly three-and-a-half times higher in patients who had rhinosinusitis compared to those who did not.1PubMed Central. COVID-19-related headache and sinonasal inflammation: A longitudinal study analysing the role of acute rhinosinusitis and ICHD-3 classification difficulties in SARS-CoV-2 infection – Section: Results This sinus-driven pain tends to be dull and constant, worsened by bending forward, and usually resolves as the infection clears.
What makes COVID sinus pain trickier than garden-variety sinusitis is that the headache may also stem from the systemic viral response itself. The same study found that in 96% of headache cases, the pain could be attributed to the general viral infection rather than sinus inflammation alone.2PubMed Central. COVID-19-related headache and sinonasal inflammation: A longitudinal study analysing the role of acute rhinosinusitis and ICHD-3 classification difficulties in SARS-CoV-2 infection – Section: Results In plain terms, the body’s own inflammatory reaction to the virus generates chemicals that sensitize pain pathways in the head and face. So even patients without obvious nasal stuffiness can develop headache and facial discomfort during COVID, driven by the immune response rather than sinus blockage.
Trigeminal Neuralgia and Neuritis
A more alarming form of COVID face pain involves the trigeminal nerve, the large nerve responsible for sensation across the forehead, cheeks, and jaw. Some patients develop trigeminal neuralgia, characterized by sudden, electric-shock-like jolts of pain along one side of the face. In one reported case, a 65-year-old man experiencing typical COVID respiratory symptoms developed paroxysmal, lancinating pain in the upper division of the trigeminal nerve on the right side, with no other neurological problems. His facial pain resolved as the COVID infection improved.3Headache: The Journal of Head and Face Pain. Trigeminal neuralgia as the sole neurological manifestation of COVID‐19: A case report – Section: Results Other case reports describe similar presentations.4Archives of Clinical and Experimental Ophthalmology. A case of trigeminal neuralgia after COVID-19 – Section: Abstract
Trigeminal neuritis, where the nerve becomes inflamed rather than generating classic shock-like pain, has also been documented. A 26-year-old patient with no prior medical history developed reduced sensation in the right side of the face after five days of flu-like symptoms. MRI revealed abnormal signal and enhancement along the right trigeminal nerve, consistent with neuritis, and a COVID PCR test came back positive.5PubMed Central. Post COVID-19 trigeminal neuritis: Case report – Section: Case presentation Instead of sharp pain, this patient experienced numbness. The key takeaway is that the trigeminal nerve can be affected in more than one way: some people get stabbing pain, others get numbness or tingling, and occasionally both overlap.
A systematic review looking specifically for facial pain attributed to COVID in the published literature found essentially no aggregated data on the topic, despite the growing collection of individual case reports.6European Journal of Neurology. Headaches and facial pain attributed to SARS‐CoV‐2 infection and vaccination: a systematic review – Section: Results That gap means the true frequency of trigeminal involvement is unknown. It appears uncommon, but how uncommon is hard to pin down.
How the Virus Reaches Facial Nerves
SARS-CoV-2 does not simply irritate facial nerves from a distance. Research suggests the virus can physically enter nerve tissue. A review of the pathways the virus uses to reach the nervous system identified the trigeminal nerve as one of several direct routes, alongside the olfactory nerve, cerebrospinal fluid, and the bloodstream.7PubMed Central. Involvement of the nervous system in COVID-19: The bell should toll in the brain – Section: Abstract The virus latches onto ACE2 receptors, which are found on the surface of various cell types. Pain-sensing nerve fibers that supply the skin and mucosal linings express these receptors, giving the virus a molecular doorway into exactly the neurons that transmit pain signals.8PubMed Central. Neurobiology of SARS-CoV-2 interactions with the peripheral nervous system: implications for COVID-19 and pain – Section: SARS-CoV-2 neurotropism and its implications for pain and/or neuropathy
An animal study using mice infected intranasally with SARS-CoV-2 offered a closer look at what happens inside the trigeminal ganglion, the cluster of nerve cell bodies that relays facial sensation to the brain. Gene-expression analysis showed a surge in inflammatory signaling, activation of inflammasome pathways, and upregulation of genes associated with neuronal injury and pain processing.9Journal of Neuroinflammation. Intranasal SARS-CoV-2 infection changes the transcriptome of the mouse trigeminal ganglion and brainstem: potential mechanisms underlying headache and trigeminal pain presentation in COVID-19 – Section: Abstract In simpler terms, the virus arriving at the nerve hub sets off a cascade of inflammation and stress signals that could sensitize or damage the nerve fibers responsible for facial sensation. This offers a plausible mechanism for both the pain and the numbness that patients report.
Jaw Pain, Teeth Clenching, and TMJ Problems
Not all COVID-related face pain comes from the virus itself. The pandemic drove a measurable increase in temporomandibular joint disorders and bruxism (teeth grinding and clenching), which produce pain in the jaw, temples, and cheeks. A study comparing patients across pre-pandemic, during-pandemic, and post-pandemic periods found that the odds of being diagnosed with painful TMJ disorders after the pandemic subsided were about 3.3 times higher than before COVID arrived. Sleep bruxism and awake bruxism also rose sharply, with the odds of awake bruxism roughly 3.2 times higher in the post-pandemic period. Women were hit especially hard, with odds of TMJ diagnosis about 3.7 to 4.4 times higher than men.10PubMed Central. The continuous adverse impact of COVID-19 on temporomandibular disorders and bruxism: comparison of pre- during- and post-pandemic time periods – Section: Results
These findings likely reflect the combined effects of pandemic-era stress, anxiety, disrupted sleep, changes in daily routine, and extended screen time. People under psychological strain tend to clench their jaws, often without realizing it, especially during sleep. The resulting muscle fatigue and joint strain produce a dull, aching pain across the side of the face and around the ear that can mimic sinus pain or even a toothache. If you developed face pain during or after the pandemic and it worsens with chewing, yawning, or talking, TMJ dysfunction is worth considering as a cause, particularly if dental and sinus evaluations are unremarkable.
Burning Mouth, Facial Numbness, and Other Sensory Changes
Beyond classic pain, COVID can produce a range of abnormal sensations in the face. Burning mouth syndrome, a persistent burning or scalding feeling in the tongue, gums, or palate without a visible cause, has been reported both during and after COVID infection. Limited prevalence data suggest that the condition occurred in roughly 4% of mild-to-moderate COVID cases during active illness and around 15% after recovery, while hospitalized patients also reported rates around 15%.11PubMed Central. COVID-19-Related Burning Eye Syndrome and Burning Mouth Syndrome: A Systematic Review and Meta-analysis – Section: Results Those numbers come from only two small studies, so they should be treated cautiously, but the pattern is consistent with the virus affecting the small sensory nerves in the oral mucosa.
Persistent facial numbness or tingling that appears after a respiratory illness suspected to be COVID has also been documented. One case involved a 34-year-old man who developed unilateral paresthesia of the upper lip and the area just below the eye following an upper respiratory illness. The pattern was consistent with damage to the infraorbital nerve, one of the branches of the trigeminal nerve.12Case Reports in Dentistry. Persistent Unilateral Nerve Paresthesia Following Suspected Viral Infection – Section: Abstract Sensory testing in another patient with post-COVID trigeminal neuropathy showed reduced ability to detect temperature changes and light touch on the affected side of the face, along with an abnormal increase in sensitivity to mechanical pain, suggesting that nerve damage and a sensitized pain system were operating simultaneously.13PubMed Central. Trigeminal neuropathy presenting secondary to SARS-CoV-2 infection – Section: Results
When Face Pain Signals Something More Serious
In a small number of COVID-19 patients, facial pain is an early warning of a dangerous secondary infection. Mucormycosis, sometimes called “black fungus,” is a rapidly progressive fungal infection that gained attention during the COVID pandemic, especially in parts of South Asia. It typically strikes patients who are diabetic, immunosuppressed, or who received prolonged courses of steroids and supplemental oxygen during COVID treatment. The fungus invades the sinuses and can spread to the eye socket and brain.
Symptoms include facial pain, numbness, swelling around the eye, sinus congestion, blurred vision, and headache. In one reported case, a 51-year-old diabetic man treated for COVID developed swelling around the left eye along with tooth pain, and imaging revealed rhino-orbital mucormycosis.14PubMed Central. Rhino-orbital mucormycosis in COVID-19 (Corona Virus Disease): A case report – Section: Abstract A hallmark of the disease is tissue necrosis, where affected areas of the nose, palate, or skin turn black as the fungal hyphae invade blood vessels and cut off circulation.15Journal of the Scientific Society. Coronavirus Disease 2019-associated Mucormycosis of the Head-and-neck Area – Section: Clinical Presentations Diabetic patients recovering from COVID who develop new facial pain, swelling, or nasal crusting should seek urgent medical evaluation because early surgery to remove dead tissue improves survival.16PubMed Central. Imaging of COVID-19-associated craniofacial mucormycosis: a black and white review of the “black fungus” – Section: Abstract
Another severe but less common scenario involves reactivation of dormant viruses. COVID-19’s effect on the immune system can allow herpes zoster (the virus behind shingles) to reactivate, producing painful blisters and nerve pain in the face. When herpes zoster affects the facial and auditory nerves, it can cause Ramsay Hunt syndrome, with facial paralysis, ear pain, and a rash. Case reports describe this occurring as a presenting symptom of COVID in patients who had no idea they were infected.17American Journal of Case Reports. Zoster Cranial Polyneuropathy in a COVID-19 Patient – Section: Conclusions
Face Pain That Persists After COVID Clears
For some people, facial pain does not resolve when the acute infection ends. Long COVID, broadly defined as symptoms lasting weeks to months after initial recovery, can include persistent facial pain and headache. One proposed explanation focuses on microvascular damage. SARS-CoV-2 targets ACE2 receptors on the cells lining small blood vessels. The resulting inflammation and clotting in tiny vessels may impair blood flow to nerves long after the virus is gone, creating a state of delayed microvascular healing that sustains pain.18PubMed Central. The microvascular hypothesis underlying neurologic manifestations of long COVID-19 and possible therapeutic strategies – Section: Headache and facial pain syndromes
Cluster headache, a rare but extremely painful condition that produces intense burning or stabbing pain behind one eye with associated tearing and nasal congestion, has also been reported in connection with COVID. The proposed mechanism involves the virus entering the trigeminal ganglion and triggering the release of pain-signaling molecules like substance P and CGRP, which drive both inflammation and the autonomic symptoms (tearing, nasal congestion, eyelid drooping) seen in cluster attacks.19PubMed Central. Fever of Unknown Origin and Cluster Headache: A COVID-19 Conundrum – Section: Discussion These presentations remain infrequent, but they illustrate how broadly the virus can disturb the facial pain system.
Treatment Approaches
Treatment depends entirely on which type of face pain is involved, and getting the right diagnosis is the crucial first step.
- Sinus-related pain: Standard approaches for rhinosinusitis apply. Saline nasal irrigation, nasal corticosteroid sprays, and over-the-counter pain relievers generally help while the viral infection runs its course.
- Trigeminal neuralgia: Classic first-line medications for nerve pain, such as carbamazepine, are typically used. In at least one case where the neuralgia was directly tied to COVID, the pain resolved on its own as the infection cleared.
- TMJ and bruxism pain: Oral splints, jaw exercises, stress management, and sometimes physical therapy address the muscular and joint components. Identifying and reducing clenching habits during the day is often the most effective starting point.
- Neuropathic pain after COVID: This can be stubborn. One documented case involved a patient who tried low-dose amitriptyline and nortriptyline without benefit, then escalated to pregabalin with minimal relief even at higher doses. A tapering course of oral prednisolone, starting at 60 mg daily and reducing over several weeks, finally dropped the patient’s pain score from 7 out of 10 down to about 2 out of 10.20PubMed Central. Neuropathic pain post-COVID-19: a case report – Section: Treatment
For severe, refractory headaches during acute COVID, nerve blocks have shown promise. A case series described six patients with COVID-related headaches unresponsive to standard pain medication who received sphenopalatine ganglion blocks, a quick procedure done at the bedside using a small intranasal applicator with local anesthetic. All six experienced a drop from severe pain to mild or no pain, with no recurrence through hospital discharge.21PubMed Central. Sphenopalatine ganglion block for refractory COVID-19 headache: a descriptive case series – Section: Discussion This is a small series and not standard practice, but it suggests that interventional pain techniques deserve more study for patients whose COVID face and head pain resists medication.
Facial Pain After COVID Vaccination
A small number of case reports describe trigeminal neuralgia appearing shortly after COVID-19 vaccination, distinct from the infection itself. One patient developed pain the day after receiving a third dose of the Pfizer-BioNTech vaccine and was diagnosed with trigeminal neuralgia at a neurology department, with no other identifiable cause found.22PubMed Central. Trigeminal neuralgia occurring after the third dose of Pfizer BioNTech COVID-19 vaccine. Complication or coincidence? An illustrative case report and literature review – Section: Abstract Another report documented acute trigeminal neuritis following the same vaccine.23PubMed Central. A case of trigeminal neuralgia developing after a COVID-19 vaccination – Section: Abstract
These remain isolated reports, and the temporal link between vaccination and symptom onset does not prove causation. Trigeminal neuralgia occurs in the general population for many reasons, so some cases will coincide with vaccination by chance. The authors of these reports describe the association as plausible but unproven. From a practical standpoint, if you develop new facial pain within days of a COVID vaccine, it is worth mentioning the timeline to your doctor, but the evidence does not suggest this is a common risk.
Distinguishing the Source of Your Face Pain
One reason COVID-related facial pain can be confusing is that multiple mechanisms can operate in the same person at the same time. You might have sinus inflammation creating pressure across your cheeks while pandemic stress is driving jaw clenching that adds pain along the temples and ear. Or a trigeminal nerve irritated by the virus might produce both numbness in one patch of skin and heightened sensitivity in the area beside it. Sorting out the contribution of each factor usually requires a systematic approach: dental evaluation to rule out tooth pathology, sinus imaging if congestion is persistent, and neurological assessment if the pain has a sharp, electrical quality or is accompanied by numbness.
A few features can help point you in the right direction. Sinus pain tends to be bilateral, dull, and worse with forward bending. Trigeminal neuralgia produces brief, intense shocks triggered by light touch, chewing, or even a breeze on the face, usually on one side only. TMJ pain is often worst in the morning (from overnight grinding), is focused around the jaw joint just in front of the ear, and may come with clicking or limited mouth opening. Burning mouth syndrome produces a steady burning or scalding quality, usually without visible changes to the oral tissues. And mucormycosis, though rare, announces itself with progressive swelling, darkening tissue, and worsening pain in someone who is immunocompromised. Recognizing these patterns helps you and your clinician zero in on the right cause and avoid treatments aimed at the wrong target.