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I did mri for my neck that showed dehydrated discs from c2 to c4 and herniated disc at c5 c6 level can that be the reason for my facial pain and tingling and head tingling?
15 أغسطس 2014
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د. Rania Mousa الطب العام
Yes of course .
It is interesting to note as i mentioned in my previous answer , that cervical disc bulges and pressures can also lead to facial symptoms .
It is frequently seen as neck pain involving the shoulder and also extending to the face. However, sometimes it may even occur without any neck involvement.
However, it has been documented in many research papers, that bulging cervical discs can cause facial pain, tingling or numbness along with neck pain or even without it. This is called cervicogenic facial pain.

The trigeminal nerve arises from the mid-brain or brain-stem (Picture 1), which is located above the spinal cord. But the nucleus of this nerve (area from where the nerve fibers forming the nerve originate), extends from the brain-stem down to the third cervical segment of the spinal cord (C3). It is surrounded by the ganglions of the spinal nerves and is known to interact with these cells (Picture 2). This functional interaction is responsible for the to and fro referral of painful sensations from neck and face. This can even result in headache, which is referred as cervicogenic headache

Several receptors are responsible for perception of sensations on the face. Touch, pain, pressure, temperature, and so on, are all perceived by individual receptors present in the skin. Nerve fibers from these receptors form sensory nerves and carry the sensations from these receptors to the brain. However, due to interconnections between these nerves the sensations from a particular area reach several nerves and reach the brain by different pathways. So if a particular nerve is damaged the neighboring nerves carry the sensations from that part. That is why, if a single nerve is damaged, it only leads to partial loss of sensations rather than complete numbness.

Diagnosis of cervicogenic facial pain is one of exclusion. It means that, disorders like epilepsy and trigeminal neuralgia are relatively common, so we have to first ensure that a person is not having a variant of these diseases. If no disease can be attributed to cause the facial pain or numbness, one can consider the bulging disc to be a cause of the pain. The prime reason for this approach is because bulging discs are frequently present in normal individuals as well.

The pattern in which pain occurs, is also characteristic in cervicogenic facial pain. The pain typically occurs during extension of the neck (as in looking upwards). Sometimes looking backwards with extreme sideways movement of the neck can also lead to facial pain or tingling and numbness. It is quite common to have neck stiffness due to disuse of neck muscles, because of the pain associated with neck movements.

in addition to the tests you have done like mri ct of brain ,Nerve conduction studies can be helpful in establishing an accurate diagnosis. Cervical nerve root blockade by anesthetic agents can be used if diagnosis is in doubt. Complete abolition of pain even at extremes of neck movements confirms the diagnosis of cervicogenic facial pain.

As for treatment
>surgical instillation of steroid in cervical region is quite helpful in providing prolonged relief from symptoms.
>drugs effective in this condition are

Antidepressants -Antiepileptics -Muscle relaxants -Botox Type A (under evaluation)
Surgical measures like spinal fusion, discectomy, or laminectomy, are infrequently required for sustained pain relief and for those wanting a terminal solution to the problem.

However, in majority of cases, medical treatment with drugs along with physical therapy is sufficient for adequate control of symptoms.
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