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Hi everyone, Shalom Aleichem!
Good afternoon GanSist everyone!
Have you ever felt pain that suddenly appeared around your lips, cheeks or temples with very high intensity? Some people describe the sensation as being like an electric shock, being stabbed by a sharp object, or burning. Pain attacks can even last only a few seconds, but their intensity is so great that they make the sufferer afraid to talk, eat, chew or wash their face.
Complaints like this are often thought of as sensitive teeth, canker sores, or ordinary disorders that will go away on their own. In fact, in some cases, severe pain in the facial area can be a sign of a disturbance in the nervous system that requires medical treatment.
My thread this time will discuss why the lips, cheeks and temples are very sensitive to pain and when these complaints need to be suspected as a nervous disorder.
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Why Are Lips and Face So Sensitive?
The human body has various types of pain receptors that function to detect dangerous stimuli. On the skin of the face, especially in the areas of the lips, cheeks and temples, there is a much higher density of sensory nerve endings than in many other parts of the body.
Two types of nerve fibers that play a major role in pain perception are A-delta and C fibers.
A-delta fibers are nerve fibers that transmit impulses at high speed because they have a thin myelin layer. These fibers are responsible for the sensation of sharp pain that appears suddenly, for example when the skin is pricked or hit by a hot object.
Meanwhile, C fibers do not have a myelin layer so they transmit impulses more slowly. However, these fibers produce a longer painful sensation, feeling throbbing, burning, or like a persistent ache.
Both types of fibers are widely distributed in facial tissue. Lips are even one of the parts of the body that has the highest density of sensory nerve endings. It is not surprising that light touches, small changes in temperature, or minor injuries can be immediately felt clearly.
The temples also have many branches of sensory nerves and temporal blood vessels, so this area is very sensitive to various stimuli.
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Role of the Trigeminal Nerve
Most of the sensations (pain, heat, cold, touch) on the lips and face are transmitted by trigeminal nerveor 5th cranial nerve.
This nerve is one of the largest nerves in the head and has 3 main branches, namely:
1) The eye branch that innervates the forehead, eyes and part of the temples
2) The maxillary branch which innervates the upper teeth, cheeks, upper lip, sinuses and upper jaw
3) The lower jaw branch which supplies the lower teeth, lower lip, chin, part of the ear and lower jaw
Due to the large area innervated, disorders of the trigeminal nerve can cause pain in various parts of the face, from the temples to the lips.
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Not All Facial Pain Comes from the Teeth
A fairly common mistake is to assume that all pain in the cheeks or lips comes from dental problems.
Indeed, cavities, abscesses, or gingivitis can cause pain that radiates to the face. However, if a dental examination does not find a clear cause, while the pain continues to appear repeatedly in a characteristic pattern, the doctor may consider the possibility of a nerve disorder.
This is important because the treatment of nervous disorders is different from the treatment of ordinary toothache. Extraction of teeth that are actually healthy has even been reported in sufferers who have not been properly diagnosed.
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Trigeminal Neuralgia, One of the Causes of Very Severe Facial Pain
One of the most well-known nerve disorders that causes excruciating pain in the face is neuralgia trigeminal.
This disease is characterized by attacks of very intense pain, usually only affecting one side of the face. The intensity of the pain is often described as one of the most severe pain a human has ever experienced.
Attacks can last for a few seconds to several minutes and can recur several times a day.
Activities that seem simple can actually trigger an attack, such as chewing food, talking, brushing your teeth, washing your face, smiling, being exposed to wind, and touching your facial skin.
In some sufferers, just a very light touch is enough to trigger excruciating pain.
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Why Does Trigeminal Neuralgia Occur?
The most common cause is the presence of blood vessels pressing on the base of the trigeminal nerve at the base of the 12 pairs of head nerves located near the brain stem.
Prolonged pressure can damage the myelin layer which functions as a nerve insulator. As a result, electrical impulses in the nerves become unstable so that even mild stimulation can be translated into very intense pain.
However, trigeminal neuralgia can also be caused by several other conditions, including multiple sclerosis, brain tumors that press on the base of the nerves, injuries to the face, complications of sinus or dental surgery, and blood vessel abnormalities. Because the causes are varied, examination by medical personnel is very important.
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Why Can the Pain Be So Severe?
Physiologically, myelin damage causes electrical impulses to “jump” to other nerve fibers. This phenomenon is referred to as ephaptic transmission. As a result, what is actually a mild stimulus turns into a very strong pain signal. The brain then perceives these impulses as a major threat even though there is no new injury to the tissue.
This is the reason why sufferers can feel pain that seems disproportionate to the stimulus received.
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Impact of Trigeminal Neuralgia on Daily Activities
Recurrent facial pain doesn’t just cause pain. Many sufferers end up experiencing a decrease in quality of life because they are afraid of triggering another attack.
Some of the impacts that are often reported include difficulty eating resulting in weight loss, fear of speaking, sleep disturbances, difficulty concentrating, decreased work productivity, fatigue easily due to recurring pain, and mood disorders.
Chronic pain that lasts a long time can also cause physical and mental fatigue because the body is constantly under stress.
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Does All Pain in the Temple Mean Trigeminal Neuralgia?
The answer is of course no. Pain in the temples has many possible causes, for example tension headaches (tension-type headache), migraines, jaw joint disorders (TMD), sinusitis, cavities, giant cell arteritisin old age, to facial muscle injuries.
Therefore, the diagnosis cannot be made based on the location of the pain alone. The doctor will consider the pain pattern, duration, location, trigger factors, patient’s age, medical history, as well as the results of physical and supporting examinations if necessary.
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When should you get yourself checked immediately?
Facial pain should not be considered trivial if it has one of the following characteristics:
1) Pain is so severe that it interferes with activities
2) It occurs repeatedly without a clear cause
3) Appears like an electric shock
4) Triggered by a light touch
5) Accompanied by numbness
6) Accompanied by facial muscle weakness
7) Does not improve with regular pain relievers
8) More frequent recurrences
The doctor may perform a neurological examination, dental examination if necessary, or imaging such as MRI to look for the underlying cause.
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How is it handled?
Treatment depends on the cause. In trigeminal neuralgia, first-line therapy generally uses drugs that work to stabilize nerve activity, not just ordinary pain relievers. If treatment does not provide adequate results or there are structural causes such as compression of nerves by blood vessels, the doctor may consider brain surgery or other procedures appropriate to the patient’s condition.
Therefore, long-term independent use of medication without knowing the cause of the pain is not recommended.
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Don’t Wait Until It Interrupts Your Life
The body has a very complex nervous system. Pain is a protective mechanism so that we are aware of disturbances.
However, if the pain appears very intense, recurs frequently, and has no clear cause, the condition is no longer just an ordinary complaint.
The lips, cheeks and temples are rich in A-delta and C nerve fibers so they are very sensitive to painful stimuli. However, this anatomical sensitivity does not mean that all pain can be considered normal. Pain attacks that are repeated, very intense, to the point of causing fatigue or interfering with daily activities should be further evaluated by a health professional.
Early detection allows the cause of pain to be found more quickly so that appropriate therapy can be given immediately. In this way, sufferers’ quality of life can be maintained, while preventing greater impacts due to untreated chronic pain.
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SOURCE
Bendtsen, L. et al. (2019). European Academy of Neurology guideline on trigeminal neuralgia. European Journal of Neurology, 26(6)831–849.
Hall, JE (2021). Guyton and Hall Textbook of Medical Physiology(14th ed.). Elsevier.
International Association for the Study of Pain. (2020). IASP terminology. https://www.iasp-pain.org
Kandel, E. R., Koester, J. D., Mack, S. H., & Siegelbaum, S. A. (2021). Principles of Neural Science (6th ed.). McGraw-Hill.
National Institute of Neurological Disorders and Stroke. (2025). Trigeminal neuralgia fact sheet. U.S. National Institutes of Health.
Snell, R. S. (2019). Clinical Neuroanatomy (8th ed.). Wolters Kluwer.
Zakrzewska, J. M., & Linskey, M. E. (2014). Trigeminal neuralgia. BMJ, 348g474.
