Trigeminal Neuralgia: When It’s More than Just Facial Pain

Trigeminal neuralgia is a type of nerve pain that affects the face. You may feel a strong burst of pain on one side of your face that is most often on the jaw or cheek. Typically, the pain is “electric” or sharp and may last a few seconds to a minute or so, and it may be so severe that you can’t eat or drink. Trigeminal neuralgia can be triggered by innocuous things like brushing your teeth, or even sometimes the sensation of wind on your cheek.

“Many of my patients can identify the exact moment their trigeminal neuralgia started,” says Gregory Lekovic MD PhD, neurosurgeon at PIH Health. “Then the pain starts to come and go, often in bursts that last anywhere from a few seconds to two minutes. During a flare of the condition, these bursts of pain may occur more often until the pain almost never stops. The pain can be so severe it can make it hard to get through your day. The most common areas for the pain to occur include the jaw line and the midface including the upper teeth. The pain is commonly mistaken for tooth pain, any many patient’s first thought is to see their dentist.”

This chronic pain condition can flare up for a few weeks or months. Then the pain goes away for a while, sometimes years.

What causes trigeminal neuralgia?

“The vast majority of trigeminal neuralgia is caused by an artery in the brain pressing on the nerve that normally provides sensory information about the face to the brain. This nerve is called the trigeminal nerve. However, rarely, other conditions can cause trigeminal neuralgia, most notably multiple sclerosis, shingles, or a brain tumor. For this reason, an MRI should be obtained.”

“This condition happens most often in people older than 50, but younger people can also have it,” says Dr. Lekovic. “Trigeminal neuralgia is more common in women than men.”

The trigeminal nerve is reporting information to the brain all the time, but with compression of the nerve, “normal” feelings can be interpreted by the nerve to be harmful. Practically speaking, this means that normal stimuli can become the source of severe pain. We call these “triggers”. The pain can be triggered by pressure on your cheek. This pressure can come from a razor when shaving or from your fingers when putting on makeup. Brushing your teeth, standing in the wind, washing your face, eating, drinking, and even talking may also trigger attacks of pain.

What are the symptoms of trigeminal neuralgia?

People with trigeminal neuralgia may have the following symptoms:

• Flashes of severe pain in the cheek or jaw on one side
• Absence pain between the flashes of pain
• The pain feels like electric shocks
• Pain is often triggered by wind or touching, eating, or brushing your teeth
• Anxiety from the thought of the pain returning

How is trigeminal neuralgia diagnosed?

“To diagnose trigeminal neuralgia, the physician will take the patient’s health history and do a physical exam. Giving your details about the pain may help with making a diagnosis. This includes information such as where and when the pain happens. The physician may prescribe an imaging test to try to rule out other causes of pain,” says Dr. Lekovic.

How is trigeminal neuralgia treated?

The front-line treatment for TN is medication, which is very effective but sometimes is not tolerated due to side effects, or over time loses efficacy. If and when medication ceases to be of benefit some sort of surgical or radiosurgical intervention is likely to be recommended. Generally speaking, microvascular decompression is the most effective treatment but is a brain surgery that requires a two- or three-day hospitalization, whereas radiosurgery is not as effective but does not require hospitalization. The third category of procedures, including balloon, alcohol, and thermal rhizotomy is generally reserved for patients that are too frail for surgery and need immediate relief.

Most common over the counter and prescription pain medicines don’t work for people with this condition. Treatment for trigeminal neuralgia may include:

• Anticonvulsant medicine
• Tricyclic antidepressants
• Microvascular decompression surgery
• Biofeedback
• Stereotactic radiosurgery
• Percutaneous balloon rhizotomy
• Radiofrequency ablation

Can trigeminal neuralgia be prevented?

Experts don’t know how to prevent trigeminal neuralgia. You may learn to stop doing certain activities that seem to trigger the pain more than others.

How to manage trigeminal neuralgia?

“This condition is not fatal, but the pain and anticipation of the pain can interfere with your life,” says Dr. Lekovic. “Working closely with your physician will help you find the best pain management methods for you.”

To find a doctor go to PIHHealth.org/Doctors

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