Can Migraines Cause Severe Pain in the Right Side of the Face?

Can migraines cause severe pain on the right side of the face, especially around the eye? I have already sought medical attention but the pain persists?

Recently, I have been experiencing pain near my right eye extending to the temple area, resembling sharp, intermittent pain, which has affected my sleep quality (often feeling half-awake).
I visited a doctor during the New Year holiday and went to the emergency department to see an ophthalmologist.
They noted that my intraocular pressure was slightly elevated (22 in the left eye and 23 in the right eye), but my retina appeared normal.
The doctor suggested that the increased screen time during the New Year’s Eve celebrations might be the cause, and prescribed eye drops and pain medication.
However, aside from the pain medication, the eye drops did not resolve the issue, and the sharp pain persisted.
The ophthalmologist mentioned that it could be related to migraines and recommended that I see a neurologist.
On the fifth day of the New Year, I consulted a neurologist, explaining my symptoms and mentioning that I had experienced migraines in the past, though infrequently.
I specifically noted that this time the pain was only on the right side.
At the time of the visit, I was not experiencing an attack, so the doctor conducted some simple tests (assessing balance and coordination, which were normal) and prescribed medication including pain relievers and gastrointestinal medication (to be taken as needed during pain episodes) along with migraine medication.
However, after returning home and taking the migraine medication following lunch, I experienced an attack around 3:00 p.m.
The pain was unbearable, preventing me from sleeping.
About ten minutes later, unable to tolerate the pain, I took the gastrointestinal medication and pain reliever prescribed by the neurologist at 3:30 p.m.
After half an hour, there was no improvement, and the pain intensified along with tearing.
Feeling desperate, I took the pain medication prescribed by the ophthalmologist (which had been effective previously) at 4:00 p.m.
After another half hour, there was still no relief, so I took another dose of the ophthalmologist's pain medication, which provided some improvement by 4:30 p.m.
However, I still felt mild pain, so I asked my mother for a sleeping pill at 5:30 p.m.
After taking it, I was able to sleep without pain.
I woke up about two and a half hours later at 7:30 p.m., feeling completely normal, and I was able to sleep well.
Today, I went to work without any pain, but I am still very anxious about the possibility of sudden pain episodes.
Yesterday, I took six pills, and the attacks seem to occur mostly around midday, so I am very concerned about experiencing another episode.
I would like to ask the doctor to evaluate whether the underlying issue is indeed related to neurological problems or if there could be other causes.
Thank you!

Miss Lin, 20~29 year old female. Ask Date: 2016/02/13

Dr. Gao Chunde reply Neurology

Please find time to see a neurologist as soon as possible, and inform the doctor about the time of your daily episodes and accompanying symptoms.
This is a specific type of headache known as trigeminal autonomic cephalalgia, characterized by severe unilateral pain, tearing, sudden onset, and in some cases, conjunctival injection, ptosis, facial and eyelid edema, nasal congestion, and rhinorrhea.
The treatment medications differ from those used for general headaches.

Reply Date: 2016/02/13

More Info

Migraines can indeed cause severe pain in the right side of the face, and your symptoms seem to align with this possibility. Migraines are a type of primary headache disorder characterized by recurrent headaches that can be moderate to severe in intensity. They often present with additional symptoms such as nausea, vomiting, and sensitivity to light and sound. In some cases, migraines can also cause facial pain, particularly if the pain radiates from the head to the face, which can happen due to the involvement of the trigeminal nerve.

The trigeminal nerve is responsible for sensation in the face and motor functions such as biting and chewing. It has three branches: the ophthalmic, maxillary, and mandibular nerves. If a migraine triggers pain in the ophthalmic branch, it can lead to discomfort around the eye and forehead, which may explain the pain you are experiencing near your right eye and temple. This type of facial pain can sometimes be mistaken for other conditions, such as sinusitis or dental issues, but it is essential to recognize that migraines can manifest in various ways.

Your experience of having high eye pressure and the subsequent treatment with eye drops and pain medication suggests that your healthcare providers are considering multiple factors that could contribute to your symptoms. While elevated intraocular pressure can lead to discomfort, it is crucial to address the possibility of migraines, especially since you have a history of them. The fact that your symptoms improved after taking the pain medication indicates that they may be related to a migraine attack.

It is also worth noting that migraines can be triggered by various factors, including stress, lack of sleep, certain foods, and prolonged screen time, which you mentioned during the holiday season. The combination of these factors could have contributed to the onset of your recent migraine episodes.

Given your concerns about the unpredictability of your migraine attacks, it is advisable to maintain a headache diary. This diary should include details about the frequency, duration, and intensity of your headaches, as well as any potential triggers you identify. This information can be invaluable for your healthcare provider in tailoring a treatment plan that suits your needs.

In terms of management, it is essential to follow the advice of your neurologist. They may recommend preventive medications if your migraines are frequent or severe. These can include beta-blockers, anticonvulsants, or antidepressants, which have been shown to reduce the frequency of migraine attacks. Additionally, lifestyle modifications such as maintaining a regular sleep schedule, staying hydrated, managing stress, and avoiding known triggers can also help reduce the frequency and severity of migraines.

If your migraines continue to be unmanageable or if you experience any new or unusual symptoms, it is crucial to follow up with your healthcare provider. They may consider further diagnostic testing, such as imaging studies, to rule out other potential causes of your facial pain.
In conclusion, while migraines can indeed cause severe pain in the right side of the face, it is essential to work closely with your healthcare provider to develop an effective management plan tailored to your specific symptoms and triggers. By doing so, you can improve your quality of life and reduce the fear of unexpected migraine attacks.

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