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Trigeminal neuralgia (TN) is a sudden, severe facial pain often described as sharp shooting pain or like having an electric shock in the jaw, teeth or gums. It usually happens in short, unpredictable attacks that can last from a few seconds to about 2 minutes. In most cases, trigeminal neuralgia affects just one side of the face, with the pain usually felt in the lower part of the face.
Symptoms
People with TN may experience regular attacks of pain for days, weeks or months at a time. In severe cases, pain attacks may happen hundreds of times a day. The pain can improve or even disappear altogether for several months or years at a time. However, these periods tend to get shorter with time. Some people may then develop a more continuous aching, throbbing or burning sensation, sometimes accompanied by sharp attacks.
Simple routine activities such as face washing, touching the face, brushing the teeth, or eating can trigger facial pain. Sometimes, a cold stream of air conditioning or movement of the face or head can also start trigeminal neuralgia. However, sometimes the pain can happen without a catalyst. Living with TN can be very difficult. It can significantly impact a person’s quality of life, resulting in problems such as weight loss, isolation and depression.
What causes trigeminal neuralgia?
The trigeminal nerve transmits touch and pain sensations of your face, teeth and mouth to your brain. Trigeminal nerve compression is the usual cause of TN. A nearby blood vessel pressing on the part of the nerve inside the skull or a tumour is a possible pathology in TN. In addition, multiple sclerosis (MS) can also injure the trigeminal nerve.
Who’s affected?
TN affects more women than men, and it usually starts between 50 and 60.
When to seek medical advice?
See a medical doctor if you experience persistent facial pain, particularly if standard painkillers, such as paracetamol and ibuprofen, do not help. A dentist has ruled out any dental causes. However, diagnosing TN can be difficult, and several brain scans are needed to exclude tumours or vascular loops which press on the trigeminal nerve.
Treatment for trigeminal neuralgia
Trigeminal neuralgia is usually a long-term condition, and the remission periods often get shorter. However, the treatments available do help most cases to some degree. Carbamazepine often used to treat epilepsy, is the first treatment usually recommended to treat trigeminal neuralgia. Carbamazepine can relieve nerve pain by slowing down electrical impulses in the nerves and reducing their ability to transmit pain messages. It would be best to take Carbamazepine several times a day, with the dose gradually increasing for a few days or weeks so the medicine levels can build up in your bloodstream. Then, continue the medicine for as long as necessary when the pain improves.
If this medicine does not help you, causes too many side effects, or you’re unable to take it, you may be referred to your doctor to discuss alternative medicines or surgical procedures that may help.
If you’re entering a period of remission, where your pain goes away, stopping carbamazepine should always be done slowly, over days or weeks, unless your doctor tells you otherwise.
Surgical treatment for TN
The neurosurgeon can treat trigeminal neuralgia using several procedures. First, the neurosurgeon may recommend surgery to open your skull and move any blood vessels compressing the trigeminal nerve. Research suggests this operation offers the best results for long-term pain relief. Still, it’s a major operation and carries a risk of potentially serious complications, such as hearing loss, facial numbness or, very rarely, a stroke.
Minimally invasive procedure such as radiofrequency ablation of the trigeminal nerve can be performed to damage the nerve to stop it from sending pain signals – but these are generally only effective for a few years when you are not fit for major surgery.
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