Head and Tooth Pain: When to Seek Neurological Help

Head and tooth pain?

Hello Doctor, I am a 23-year-old female.
I have been experiencing pain in my head and teeth for a week.
The headache is located on the left side, above the ear, extending to the top of the head.
Accompanying symptoms include sharp pain in the lower left teeth, which also hurts when I eat.
Occasionally, I experience sharp pain in my temples.
Sometimes, there is sudden, intense pain in my left ear.
In front of my left ear, around the area of the trigeminal nerve, I occasionally feel a sharp, electric-like pain that lasts for about a second; sometimes it occurs in quick succession, and other times there are longer intervals between episodes.
However, the pain in my head and teeth is continuous.
I found information online regarding nerve and dental issues, but I am unsure which specialist to consult.
I would like to hear your advice first.
Thank you, Doctor!

zhen, 20~29 year old female. Ask Date: 2023/06/24

Dr. Jiang Junyi reply Neurology

Hello Ms.
Zhyn,
You mentioned that "the location of the trigeminal nerve sometimes feels like being scratched by something, with a sharp pain similar to an electric shock lasting for a second; sometimes it occurs continuously, and other times with longer intervals.
However, the pain in the head and teeth is persistent." Trigeminal neuralgia should be considered first.
The diagnostic criteria for trigeminal neuralgia are as follows:
- At least three attacks
- Pain occurs in one or more branches of the trigeminal nerve
- At least three of the following characteristics of the pain must be met:
- Lasting from a fraction of a second to two minutes, with periodic and paroxysmal episodes
- Severe pain intensity
- Electric shock-like, burning, or sharp pain
- More than three trigger points on the face
- No other obvious clinical neurological deficits
When there is a relevant medical history and symptoms that meet the above criteria, the physician will diagnose through relevant examinations and provide appropriate treatment.
Typically, examinations for peripheral nerve issues are conducted, and electrophysiological tests can assist in the diagnosis.

Nerve conduction studies: Assess the conduction velocity and waveform of large fiber nerves.

Electromyography (EMG): Evaluates muscle responses in the areas supplied by the nerve.
I recommend that you visit a neurology outpatient clinic for follow-up and consult a physician specializing in peripheral nerves, as they have more experience with EMG testing.

Thank you for your inquiry, and feel free to discuss any related questions further! Wishing you good health, peace, and joy.
Dr.
Jiang Junyi, Department of Neurology, Taoyuan Medical Center, cares about you.

Reply Date: 2023/06/24

More Info

When experiencing simultaneous head and tooth pain, especially with the specific symptoms you've described, it's crucial to consider a few potential underlying causes. Your symptoms, which include pain radiating from the area above your left ear to the top of your head, along with tooth pain in the lower left jaw and occasional sharp pains in the temple and ear, suggest a possible involvement of the trigeminal nerve (cranial nerve V). This nerve is responsible for sensation in the face and motor functions such as biting and chewing.

Given that your pain has persisted for a week, it is advisable to seek medical attention. Here are some potential causes for your symptoms:
1. Trigeminal Neuralgia: This condition is characterized by sudden, severe facial pain that can be triggered by activities such as eating, talking, or even touching the face. The pain can feel like an electric shock and may be localized to areas innervated by the trigeminal nerve, which includes the regions you are experiencing discomfort.

2. Dental Issues: Tooth pain, especially if it is associated with eating, could indicate dental problems such as cavities, abscesses, or gum disease. Inflammation or infection in the teeth or gums can lead to referred pain in the head, particularly in the areas supplied by the trigeminal nerve.

3. Sinusitis: Inflammation of the sinuses can cause pain in the forehead, cheeks, and teeth. If you have any nasal congestion or pressure, this could be a contributing factor.

4. Cervical Spine Issues: Sometimes, pain in the head and neck can be related to issues in the cervical spine, such as herniated discs or muscle tension. This can lead to referred pain in the head and jaw.

5. Migraine or Tension-Type Headaches: These types of headaches can also cause pain that radiates to the teeth and jaw. Migraines, in particular, can be associated with nausea and sensitivity to light and sound.

Given the complexity of your symptoms, I recommend the following steps:
- Consult a Dentist: Since you have tooth pain, it would be prudent to first visit a dentist to rule out any dental issues. They can perform an examination and possibly take X-rays to determine if there are any underlying problems with your teeth or gums.

- Visit a Neurologist: If dental issues are ruled out, or if your symptoms persist despite dental treatment, a consultation with a neurologist would be beneficial. They can evaluate for conditions such as trigeminal neuralgia or other neurological disorders that may be causing your symptoms.

- Consider Imaging Studies: If your neurologist deems it necessary, they may recommend imaging studies such as an MRI or CT scan to assess for any structural issues that could be contributing to your pain.

- Pain Management: In the meantime, over-the-counter pain relievers such as acetaminophen or ibuprofen may help alleviate your discomfort. However, it’s important to use these medications as directed and not rely on them long-term without consulting a healthcare provider.

In summary, your symptoms warrant a thorough evaluation by both a dentist and a neurologist to determine the underlying cause of your pain. Early intervention can lead to more effective management and relief of your symptoms. Please take care of yourself, and do not hesitate to seek medical attention promptly.

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