Trigeminal Neuralgia

What is trigeminal neuralgia?

James is a 65-year-old man who awoke one day with severe pain in his face and jaw. The pain seemed to tear through his face like a lightning bolt. It was brief but excruciating pain which came in repeated flashes when activated. James could not shave over the right side of his face, chew tough foods or talk for any length of time without triggering pain. He could not even tolerate a light breeze blowing across his face.

James suffers from trigeminal neuralgia which is one of many different neuralgias. A neuralgia is a type of pain which is thought to be caused by nerve injury or irritation.

Trigeminal neuralgia, also known as tic douloureux, is a painful condition which affects the face. The trigeminal nerve provides all sensation, including pain, to the face, teeth, mouth, sinuses, meninges (coverings of the brain) and blood vessels of the head. There are two trigeminal nerves, one on each side of the head, and each has three branches supplying the upper, middle and lower parts of the face. The pain of trigeminal neuralgia is felt in the territory of one or more branches of this nerve. It usually occurs on one side of the face; in rare cases it can affect both sides at the same time. Sinuses, eyes, mouth and teeth are also innervated by the trigeminal nerve.

What does the pain feel like?

The pain is severe, brief, sharp, jolting and shock-like. A longer lasting deep, burning or dull pain may persist in between the lightening-like jolts. People with trigeminal neuralgia may have numerous attacks, up to several 100 each day. The duration of each painful jab is very brief, lasting only seconds. The pain may be triggered by chewing, talking, shaving, brushing teeth, light touch, cold air or wind blowing upon the face.

Who is the typical trigeminal neuralgia sufferer?

Trigeminal neuralgia usually occurs in people over 60 years old but may occur at any age. When trigeminal neuralgia occurs in a young person other diseases or conditions of the nerves can be possible causes. Trigeminal neuralgia can occur after an injury to the nerve such as from dental procedures including root canals, extractions, or decayed or cracked teeth. Some cases are the result of compression of the main nerve region by an artery as the nerve enters the brain stem. Some cases of trigeminal neuralgia have no identifiable cause.

Neuralgic pain is very intense and excruciating. People who have neuralgia are often depressed and frustrated. The pain affects every aspect of their lives because it occurs very frequently and rapidly without warning. People suffering with trigeminal neuralgia often find the pain to be so intense that they cannot even think clearly and may begin to believe that suicide is the only way to find relief.

What about treatments?

Fortunately, there are many different kinds of medical, anesthesiologic and surgical treatments available for the control of trigeminal neuralgia. Medications often used to control the pain of trigeminal neuralgia include carbamazepine, phenytoin, baclofen, divalproex sodium, gabapentin and clonazepam. Different kinds of anesthesiologic treatments are available including trigeminal nerve blocks, radiofrequency neurolysis (heating the nerve with a focused microwave), cryoneurolysis (freezing the nerve) and radiosurgery (radiation treatments). Surgery to expose the trigeminal nerve and remove blood vessels which may be pressing on the nerve is sometimes necessary.