Are Headaches Common in Bell's Palsy?
Headaches and periauricular pain are common associated symptoms in Bell's palsy, though not part of the core diagnostic criteria.
Associated Pain Symptoms in Bell's Palsy
Ipsilateral pain around the ear or face is a recognized associated symptom that patients with Bell's palsy may present with on examination, though it is not required for diagnosis 1
The pain typically occurs on the same side as the facial weakness and may precede or accompany the onset of facial paralysis 1
Core Diagnostic Features vs. Associated Symptoms
The diagnosis of Bell's palsy centers on:
Acute unilateral facial nerve paresis or paralysis with onset in less than 72 hours involving the forehead 1
Rapid development of unilateral facial weakness, typically over 24-72 hours 1
No other identifiable cause after thorough history and physical examination 2
While headache and periauricular pain are commonly reported, they are not part of the required diagnostic criteria and their absence does not exclude Bell's palsy 1
Other Associated Symptoms to Recognize
Beyond pain, patients may experience:
Hyperacusis (increased sensitivity to sound on the affected side) 1
Taste disturbance (altered or diminished taste on the anterior two-thirds of the tongue) 1
Dry eye and mouth due to autonomic fiber involvement 1
Clinical Pitfall to Avoid
Do not mistake the presence or absence of headache as a diagnostic criterion - Bell's palsy is diagnosed based on the pattern of facial weakness and exclusion of other causes, not on associated pain symptoms 1, 2
Bilateral facial weakness with headache is rare in Bell's palsy and should prompt investigation for alternative diagnoses such as Lyme disease, sarcoidosis, or Guillain-Barré syndrome 2