Facial numbness

I am a 45 yr old female. Two days ago I started having pains behind my right ear, that come and go. This morning realized that the right side of my face is numb and tingles. What could this be?

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

One-sided numbness is most commonly due to a problem in the brain (as opposed to other areas of the central nervous system such as the spinal cord or peripheral nerves) or trigeminal nucleus/nerve. Many possibilities exist, and depend somewhat on your age, your risk factors, and the nature of your symptoms (whether or not the numbness started suddenly or gradually, whether it is a complete loss of sensation or a tingling, whether it is an objective finding on examination or it is only a feeling that you have etc). Facial numbness can have several causes. These include migraine/headache, anxiety/panic attacks, multiple sclerosis, stroke/TIA, tumor, vascular malformations, seizure and trigeminal neuralgia to name a few.

The most concerning cause of numbness on one side is a stroke. Please understand I am not trying to imply you have a stroke, but only that this is one possibility. Strokes occur predominantly in people with risk factors: smokers, high cholesterol, diabetics, hypertensives, and people over the age of 55. However, they can occur in any age. If your numbness was due to a stroke, it would start somewhat suddenly (over minutes) and would likely persist without significant improvement.

Other potential causes as already mentioned include multiple sclerosis, a brain tumor, a vascular malformation and others. If the numbness is transient (lasting for example for minutes up to 30 minutes then resolving) could be due to a migraine (the aura of migraine, in which case following the numbness, a headache occurs) or seizures.

It is difficult to give you a more focused differential based on your symptoms you provide.  The ear pain is concerning. It may be due to headache or more serious cause including vascular abnormalities. You would benefit from evaluation by a neurologist. It would be important to you to provide information, if applicable, on headache history, rashes, additional findings in the arms/legs, and social history including life stressors, smoking history, and occupation. These items will help guide the diagnosis and workup. Depending on your history and physical examination, he/she may choose to order an MRI of the brain, which would be able to assess for several of the disorders discussed above. Also, it would be recommended to have an MRA of your vessels including carotids and Circle of Willis.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.