Why Is My Face Numb?

Heidi Moawad, MD
·10 min read

Facial numbness can be caused by several health conditions

Medically reviewed by Huma Sheikh, MD

Facial numbness refers to the loss of feeling or sensation caused by a disturbance, damage, or compression of the facial nerves. The numbness may affect part of the face or all of the face. A numb face can occur on its own or with other symptoms such as facial drooping or facial paralysis (the inability to move facial muscles).

There are many possible causes of facial numbness, including migraines, Bell's palsy, an allergic reaction, or even a stroke. Even certain medications can cause a loss of sensation in the face.

This article describes the causes and symptoms of facial numbness, including how the different conditions are treated or prevented. It also explains when it is time to seek medical care if part or all of your face suddenly goes numb.

<p>Adene Sanchez / Getty Images</p>

Adene Sanchez / Getty Images

When to Seek Emergency Care

Facial numbness is never something to ignore. If you experience any new, sudden, or unexpected change in sensation to your face, mouth, or head, it’s important to seek medical help immediately.

It is especially important to seek emergency care if facial numbness is accompanied by:

  • Changes in vision

  • Facial weakness or paralysis

  • Facial drooping

  • Loss of sensation on one side of the body

  • Confusion or disorientation

  • Slurring or difficulty talking

  • Difficult holding objects or using your fingers

  • Loss of coordination or falling

Causes of Numb Face

Facial numbness ultimately involves the nerves that supply sensations to the face, most notably the facial nerve (cranial nerve 7) which starts in a part of the brain called the brainstem. Many different conditions can directly or indirectly affect this cranial nerve, disrupting the transmission of nerve impulses that lead to facial numbness.

Some of the more common causes of a numb face include:

Migraine

Migraine is a neurologic disorder characterized by moderate to severe headache pain on one side of the head. Other symptoms include nausea, vomiting, dizziness, and light or sound sensitivity.

There are many types and subtypes of migraine. The one most closely linked to facial numbness is hemiplegic migraine which can cause one side of the body to suddenly feel numb or weak. This may be accompanied by changes in vision or speech. This type of migraine often runs in families but can occur spontaneously in anyone with a history of migraine with aura.

Hemiplegic migraine may be treated with nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) or prescription drugs like Topamax (topiramate). Unlike other types of migraines, hemiplegic migraines are not treated with triptans like Imitrex (sumatriptan) due to an increased risk of stroke.

Read Next: How Migraines Are Treated

Allergies

Facial numbness can be a sign of a type of allergy called allergic contact dermatitis. This is a relatively harmless condition in which contact with an allergy-causing substance (allergen) causes symptoms like skin swelling, itching, a bumpy rash, and dry, flaky skin.

The swelling is most common around the eyes and face. This may be accompanied by facial tingling and numbness that, while distressing, usually goes away on its own once the allergen is removed.

Many different allergens are linked to contact dermatitis, including soaps, detergents, fragrances, latex, poison ivy, and metals such as nickel and chrome. Removing the offending agent is the main form of treatment, but topical steroids can help ease symptoms faster.

Multiple Sclerosis

Multiple sclerosis (MS) is a progressive neurological disorder caused by the destruction of the protecting coating of nerve cells, called myelin. The loss of myelin interrupts nerve signaling, triggering a wide range of symptoms such as numbness and tingling, double vision, muscle weakness, and loss of balance, coordination, or bladder control.

One of the first manifestations of MS is optic neuritis caused by demyelination of the optic nerve (cranial nerve 2). This not only causes blurred vision and an inability to see color but also facial numbness or tingling as the adjacent facial nerve is affected.

The cause of MS is unknown Treatment may involve a wide range of prescription medications, including steroids, immunosuppressants, muscle relaxants, and antidepressants.

Related: What Is the First-Line Treatment for Multiple Sclerosis?

Stroke

A stroke is a medical emergency in which reduced blood flow to the brain causes the death of brain cells. Symptoms include one-sided arm weakness, slurring, and facial drooping. These are frequently accompanied by the loss of sensation on one side of the face or body.

There are two types of stroke:

A stroke is a medical emergency that requires rapid response, including blood thinners and possibly surgery, to restore blood flow and prevent further damage to the brain.

Related: How Stroke Is Treated

Transient Ischemic Attack

Transient ischemic attack (TIA) is similar to a stroke with the same underlying causes but with milder and possibly reversible symptoms. Also known as a "mini-stroke," a TIA is characterized by limited brain cell death and symptoms that are often non-specific and hard to pinpoint.

These include one-sided arm tingling and weakness, transient vision changes, slurring of words, loss of grip strength, and sudden loss of sensation on one side of the face. For some people, it is possible to have TIA and not even notice it.

This doesn't mean that TIAs are not serious. Studies have shown that having a TIA greatly increases your risk of a full-blown stroke in later life. Blood thinners like Plavix (clopidogrel) are commonly prescribed when TIA is diagnosed. Ongoing treatment may be recommended to reduce your future risk of stroke.

Shingles

Shingles (herpes zoster) is a skin infection caused by the reactivation of the varicella virus, the same virus that causes chickenpox.

Once you get over chickenpox, the virus doesn't disappear but instead lies dormant on the nerve roots of the spine. When the virus reactivates, often after the age of 40, it quickly multiplies and moves up from the nerve root to the skin where it causes an outbreak of painful blisters and sores. The location of the outbreak varies based on which spinal root is affected.

Reactivation of the varicella virus on the facial nerve can manifest with numbness or tingling on one side of the face prior to the outbreak. Even after the infection clears, the damage to nerves, called post-herpetic neuralgia, can cause facial pain and numbness for many months or years.

Symptoms of shingles can be greatly reduced with a course of antiviral drugs like Valtrex (valacyclovir). Shingles can also be prevented with a two-dose vaccine called Shingrix.

Bell's Palsy

Bell’s palsy is an often distressing condition that causes the sudden weakness or paralysis of facial muscles. In addition to one-sided facial drooping, a person may experience uncontrollable tearing, drooling, and one-sided facial numbness.

The cause of Bell's palsy is unknown but is thought to be the result of the reactivation of herpes simplex virus or varicella virus (albeit without the appearance of a skin rash). The symptoms usually start to improve after a couple of weeks and will resolve within six months.

There is no specific treatment for Bell's palsy, but corticosteroid drugs like prednisone or antiviral drugs like Zovirax (acyclovir) are often used.

Infections

Many different bacterial or viral infections can cause facial numbness either by affecting the facial nerve or the brainstem from where the nerve originates. The loss of facial sensation may be due to inflammation that compresses (pinches) the nerve somewhere along the nerve route.

Depending on the cause, the loss of sensation may be limited to one side of the face or only involve a small portion of the face. With systemic (whole-body) infections, the numbness may affect both sides of the face or the face as a whole.

Infections that can potentially cause facial numbness include:

  • COVID-19

  • Dental infections

  • Herpes

  • HIV

  • Lyme disease

  • Meningitis

  • Measles

  • Mumps

  • Mononucleosis

  • Tuberculosis

The treatment of infections can vary, but bacterial infections like tuberculosis generally respond well to antibiotics, while viral infections like herpes or HIV are commonly treated with antiviral drugs. Some viral infections resolve on their own without treatment.

Tumors

A tumor is an abnormal growth of cells that consolidates into a mass. It is an uncommon cause of facial numbness but one that can cause persistent or worsening symptoms. The tumor may be benign (non-cancerous) or malignant (cancerous) and affect either the facial nerve or brainstem.

One of the more common benign causes is a facial nerve neuroma. These tumors often develop after facial surgery a traumatic injury to the face. In many people, a neuroma can cause intense pain, but, in others, it may only cause persistent tingling or numbness.

A rare cancer affecting the facial nerve is called malignant peripheral nerve sheath tumor (MTNST). The tumor arises from the myelin coating on nerve cells, causing symptoms that are easily mistaken for Bell's palsy.

Surgery is sometimes used to treat facial paralysis. One of the more common approaches is nerve grafting where a piece of nerve tissue is surgically inserted to bridge areas of nerve damage.

Drug Interactions

Many medications are known to cause paresthesia (abnormal nerve sensations), including tingling, numbness, or pins-and-needles sensations. The hands and feet are most commonly affected, but certain medications can also cause paresthesia of the face.

In most cases, the sensation will be bilateral (affecting both sides of the face) and can persist until the treatment is stopped.

Among the medications known to cause facial numbness are:

With some drugs, including alcohol and certain HIV medications, exposure to the offending agent will need to be stopped to avoid permanent nerve injury.

Learn More: The Anatomy of the Brain

Are There Tests to Diagnose the Cause of a Numb Face?

Many tests can help identify the underlying cause of facial numbness. Sometimes the cause is known and there may not be a need for tests—such as when it occurs with an anesthetic.

If you are being seen by a healthcare provider for face numbness, your medical history and physical examination may point to an underlying cause, such as a stroke, fracture, or multiple sclerosis. A mouth examination and dental evaluation may identify the underlying problem.

You may need to have diagnostic tests as part of your evaluation. Tests that may be used during an evaluation of facial numbness:

  • A mouth X-ray may identify a dental abscess or facial bone fracture.

  • Brain imaging tests, such as computerized tomography (CT), magnetic resonance imaging (MRI), or ultrasound, can diagnose a stroke, MS, brain tumor, or vascular malformation.

  • Electrodiagnostic studies may identify patterns consistent with nerve damage or neuropathy.

Summary

Face numbness feels uncomfortable, and it may be associated with pain and other symptoms. There are many causes, and the associated symptoms may help point to the cause.

Unexpected face numbness is a medical emergency that requires urgent evaluation because some of the causes can be life-threatening if not treated promptly. There are different treatments for the causes of facial numbness, and the associated pain can also be treated as the underlying condition resolves.

Read the original article on Verywell Health.