A feeling of numbness or a sensory disorder is an altered sensation, which is usually caused by an inadequate response of the nerves to a stimulus. The stimulus can be touch, temperature, vibration or pain. This discomfort can feel differently, for example in the form of a tingling sensation (paresthesia) or a furry feeling and can occur anywhere, including on the face.
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The causes of numbness in the face can be many. In principle, damage or irritation to a nerve can be responsible for this. This can occur with a peripheral nerve inflammation, for example with herpes viruses (shingles) or with a central inflammation in the case of multiple sclerosis. If the numbness is accompanied by symptoms of paralysis, one should think of a stroke as a possible cause and see a doctor immediately.
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Find out all about the topic here: The sensitivity disorder.
However, if no physical or so-called organic cause can be found, a psychosomatic disorder should also be considered. These are patients who have had traumatic experiences, abuse or stress in the past. When confronted again with a stressful situation, those affected react with physical symptoms, which, however, are not due to any physical illness. In this large group of psychosomatic disorders there is dissociative sensitivity and sensation disorder, which can manifest itself as numbness or pain.
Read more on the topic: Psychosomatics
Not only patients with a psychosomatic disorder can develop numbness from stress. During a prolonged stress phase, the cortisol level is increased as a stress hormone in the blood. In the long term, this can weaken our immune system and make us more susceptible to inflammation. One example of this is the aforementioned shingles, which reactivate the chickenpox virus and attack the nerves in the face. Sensitivity disorders can occur here, but these are usually followed or accompanied by severe pain, blisters and redness.
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Another cause that can cause discomfort in the face is inflammation of the sinuses (sinusitis). Typical for this is a feeling of pressure, but also severe pain in the area of the affected sinus. The tenderness to pressure is usually in the forehead, between the eyes or in the area of the jaw. The nose is concomitantly blocked and can secrete purulent secretions. The general condition is usually poor and a fever may occur. Since this is a bacterial inflammation, you should see a doctor immediately.
For more information, see: Sinus infection
Another inflammation that causes referred pain and hypersensitivity in the face, but especially in the ear, is acute otitis media. This is often a mixed infection of viruses and bacteria, which typically accompanies a viral respiratory infection or occurs when the middle ear has ventilation problems. Concomitant symptoms can be fever, hearing impairment and a general feeling of illness. If you suspect an otitis media, you should consult a doctor.
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Read more on the topic: Signs of otitis media
Migraines can be another cause of numbness in the face. The symptoms of migraines are classically strong unilateral headaches, which are often accompanied by nausea, sensitivity to light and noise. However, focal neurological symptoms, the so-called aura, can occur even before the migraine attack. These symptoms can be diverse, for example visual field defects, flickering, speech disorders, but also sensitivity disorders can occur. Thus, a sudden numbness of the face, with known migraines, can be an aura. The duration of the aura must not exceed 60 minutes, after which a medical consultation should take place immediately. Usually the aura is followed by the severe headache, but sometimes it doesn't.
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An underactive thyroid (hypothyroidism) often comes with a whole range of unspecific symptoms. Typically, patients are faced with decreased performance, constipation, weight gain, and cold intolerance. Numbness can rarely occur, but this symptom is not specific to thyroid disease.
Read more on the topic: Symptoms of an underactive thyroid
In the case of numbness, the question often arises whether the cause could be the spine. It is generally true that changes in the spinal column, for example in a herniated disc, can cause sensory disorders. In the specific case of numbness in the face, however, this cannot be due to the cervical spine. If there was a herniated disc in the area of the first cervical vertebrae, the back of the head would most likely be affected. The nerves from the spinal cord are not responsible for the sensitivity of the face, but the so-called trigeminal nerve, which runs independently as a cranial nerve and does not emerge from the spinal cord.
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Find out more about the topic: Nerve damage
Sensory disturbances in the ear or cheek area can also be early symptoms. In the case of a sudden hearing loss, the symptoms often begin with a furry feeling in the auricle or the feeling as if you had "cotton wool in your ear". The main symptom is the painless inner ear hearing loss. In some cases, numbness of the cheek can occur as an early symptom of facial paralysis (facial paralysis). In both cases you should get a medical examination immediately.
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The diagnosis of a sensory disorder in the face is mainly based on the patient's clinic. The description of the complaints and the clinical examination are very important at this point. The exact survey of the symptoms and possible accompanying symptoms, as well as underlying diseases is the first step. In the clinical examination, the different stimuli such as touch, pain, temperature and vibration should be tested. A thorough physical and neurological examination is essential to determine the cause.
Important accompanying symptoms are paralysis or speech disorders. In the case of circulatory disorders in the brain, numbness of the face can be accompanied by paralysis of the face and arm or the whole body. In this case you should get medical help immediately. In the case of sensory disorders, one should also think of multiple sclerosis, which can be accompanied by other neurological deficits such as paralysis, eye movement disorders or visual disturbances.
Other abnormal sensations that can occur in the face are pain. This can be what is known as trigeminal neuralgia, which is often caused by a blood vessel compressing the trigeminal nerve. The pain is electrifying, lightning-fast, one-sided and very strong. The duration is a few seconds, but the attacks can be repeated up to 100 times a day.
As the attack progresses, a dull pain persists. Facial pain can also occur due to a cluster headache. This is also the strongest pain, which mainly occurs in the eye area and is strictly one-sided. The attacks usually occur at night and last between 15 and 180 minutes. These can be repeated up to 8 times during the day. Concomitant symptoms are increased tearing of the eyes and redness, runny nose or sweating of the half of the face. The cluster headaches usually accumulate in certain periods and can be completely absent between the episodes.
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Drugs from epilepsy therapy are used to treat trigeminal neuralgia, and they work well with this type of pain. The drug of first choice would be carbamazepine, which is slowly increased and taken as monotherapy. For acute pain, carbamazepine can be taken in its fast-acting form. If the response is good, the therapy can be slowly reduced over time. It is important to note with trigeminal neuralgia that normal pain relievers such as ibuprofen or paracetamol have no effect.
The therapy for acute cluster headache consists of inhaling 100% oxygen and taking triptans, which can be taken as a syringe under the skin or as a nasal spray. In this disease, prophylaxis plays a major role, as the pain is a great torment for the patient. Cortisone is usually administered as short-term prophylaxis, but long-term prophylaxis should always be considered. Verapamil, a calcium antagonist, is primarily used here. Again, normal painkillers are ineffective.
For more information on epilepsy therapy, see: Drugs for epilepsy
The duration of the trigeminal attack is limited to a few seconds, but as mentioned above, they can be repeated very often in a row. About a third of patients only experience one episode in their life. However, this condition often worsens over the course of life. Over 50% of those affected have pain-free phases for more than six months. For every fifth person, these phases last for over a year. A distinction is made between the episodic and the chronic form of cluster headache. In the episodic form, which about 75% of patients have, these are symptom-free for at least one month. 25% of those affected suffer from chronic pain that has no or only short periods of freedom from pain.
Find out more about the topic: Cluster head joke
Therapy for trigeminal neuralgia has a relatively good prognosis.About 80% of the patients respond well to the medication, but in the course of the drug, higher and higher doses are necessary for the same effect. However, there are several drugs that can be tried. Under certain conditions, the compression of the nerve can be surgically removed, with very good success rates of up to 82% pain-free patients.
The prognosis for cluster headache is somewhat modest with spontaneous healing of 40% in the episodic form and 17% in the chronic form. In up to 15% of cases the episodic headache turns into a chronic form. However, both the oxygen and the drugs have very good response rates and can relieve the pain quickly.
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