Differential Diagnosis for Severe Unilateral Facial Pain

The symptoms described suggest a condition affecting the nerves or blood vessels on one side of the face. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Trigeminal Neuralgia: This condition is characterized by sudden, severe, shock-like or stabbing pain around the eyes, lips, or nose mainly because of abnormal blood vessels pressing on the trigeminal nerve in the head. The pain can be triggered by factors such as touching the face or eating and typically affects one side of the face, which aligns with the symptoms described.

• Other Likely Diagnoses

  • Cluster Headaches: These are extremely painful headaches that occur in cycles or clusters, often waking the patient from sleep. They are typically centered around one eye and can radiate to other areas of the face, including the temple and forehead.
  • Migraines: While migraines are often bilateral, they can sometimes present unilaterally and involve pain in various areas of the face, including the temple, forehead, and around the eye.
  • Temporal Arteritis (Giant Cell Arteritis): This condition involves inflammation of the blood vessels, particularly those in the head, and can cause severe pain on one side of the face, especially in the temple area. It's more common in older adults.

• Do Not Miss Diagnoses

  • Stroke or Transient Ischemic Attack (TIA): While less common, facial pain can be a symptom of a stroke or TIA, especially if accompanied by other neurological deficits such as weakness, numbness, or difficulty with speech.
  • Multiple Sclerosis: This autoimmune disease can cause a wide range of neurological symptoms, including facial pain, due to lesions in the central nervous system.
  • Cranial Neuropathies: Conditions affecting the nerves that emerge directly from the brain can cause facial pain, among other symptoms.

• Rare Diagnoses

  • Raeder’s Syndrome: A rare condition characterized by a group of symptoms including unilateral facial pain, ptosis (drooping eyelid), and miosis (constricted pupil), often due to a lesion or inflammation affecting the sympathetic nerves to the face.
  • Short-Lasting Unilateral Neuralgiform Headache with Conjunctival Injection and Tearing (SUNCT) and Short-Lasting Unilateral Neuralgiform Headache with Autonomic Features (SUNA): These are rare headache disorders that cause short-lasting but very painful headaches, usually on one side of the head, with associated autonomic symptoms like tearing and redness of the eye.
  • Idiopathic Stabbing Headache: Characterized by brief, sharp pains or stabs of pain in the head, which can be unilateral and may resemble the pain described, though typically much shorter in duration.

Each of these conditions has distinct features, and a thorough medical history, physical examination, and sometimes additional diagnostic tests are necessary to determine the underlying cause of the symptoms.