Trigeminal Neuralgia: Causes and Symptoms

• Trigeminal neuralgia affects the trigeminal nerve and causes sudden attacks of severe pain on one side of the face.
• Pain is often sharp, stabbing, or like an electric shock and can be triggered by touch, shaving, chewing, or brushing teeth.
• Painful attacks last from a fraction of a second to a few minutes and can occur several times a day for days, weeks, or months.
• Some experience a constant dull ache between episodes; in some, the pain disappears for months or years.
• It is more common in women than men, and usually occurs in people over 50.

Causes of Trigeminal Neuralgia

• The cause is often unknown, but symptoms may be due to a blood vessel pressing on the trigeminal nerve in the skull.
• Rarely, it may be due to diseases like multiple sclerosis or a tumor pressing on the nerve.
• It rarely occurs in multiple people of the same family.

Symptoms of Trigeminal Neuralgia

• Trigeminal neuralgia involves repeated attacks of severe, sharp, shock-like pain in the face or mouth, lasting from a few seconds to 2 minutes.
• Attacks can occur spontaneously or be triggered by light touch, speaking, eating, shaving, hair brushing, tooth brushing, head movements, or a cool breeze.
• There are specific trigger zones on the face or in the mouth where touching these can cause an attack.
• It usually affects one side of the face, but can be bilateral in rare cases.
• Pain can be in the lower jaw, upper jaw, cheek, and less often the eye and forehead depending on which branch of the trigeminal nerve is affected.

Diagnosis & Appearance

• There are no outward physical signs; people with trigeminal neuralgia have a normal looking, healthy face and mouth.
• Diagnosis relies on the patient's description of symptoms because there is no one diagnostic test for trigeminal neuralgia.
• Radiographs (X-rays) of the teeth or jaw may be taken to help rule out other reasons for the pain, and sometimes blood tests may be required.
• Specialists may recommend an MRI (magnetic resonance imaging) scan to assess whether the disorder has been caused by a blood vessel pressing on the nerve.

Treatments for Trigeminal Neuralgia

• There is no cure, but many options are available to control the pain, or it can become dormant for long periods or disappear without specific treatment.
• Initial treatment involves medicines to control the painful attacks.
• Common pain relief medications like paracetamol or ibuprofen and stronger medications such as morphine are not useful.
• Anti-convulsants (anti-epilepsy medications) are the most effective medicines.
• Medications must be taken all the time, not just when pain is present.
• Carbamazepine effectively controls symptoms in most people but has side effects like dizziness, drowsiness, difficulties with memory and concentration.
• Blood monitoring is required to assess the effects of the drug on the liver and on blood.
• Other anti-convulsant medications used are oxcarbazepine or lamotrigine; some find a combination of medications works best.
• In prolonged severe attacks, a local anaesthetic injection into the trigger area may provide some relief and allow medications to work more effectively.
• A GP may advise on the best treatment initially.

Surgical Treatments for Trigeminal Neuralgia Treatment

• If medications are not well tolerated, a referral to a neurosurgeon may be needed for alternative surgical treatments.
• An MRI scan showing a blood vessel pressing on the nerve may warrant an operation to decompress the nerve inside the skull, called microvascular decompression.
• Operations directly treating part of the nerve are possible including:
  • Radiofrequency thermocoagulation rhizotomy: applying a heated wire to the nerve.
  • Balloon compression: inflating a balloon against the nerve.
  • Glycerol rhizotomy: depositing a liquid called glycerol adjacent to the nerve.
  • Stereotactic radiosurgery (“Gamma Knife®”): radiation therapy focusing power on the trigeminal nerve.

Additional Tips

• Maintain good oral hygiene and visit the dentist regularly.
• If one cannot brush their teeth, use an antibacterial mouthwash like chlorhexidine.
• Avoid triggers like going out in cold weather (cover your face), drinking through a straw, and avoiding very hot or very cold foods and drinks.
• Keep a pain diary to record progress, severity of pain, frequency of attacks, medication side effects, and dose of medication.
• Seek professional help if feeling sad or unable to cope with the condition; treatment is available for the low mood that can develop with chronic pain conditions.
• Review date: October 2022
• Trigeminal Neuralgia Association (UK) URL: https://www.tna.org.uk/contact/

Trigeminal neuralgia causes intense facial pain due to trigeminal nerve issues. Sharp, stabbing pain attacks are triggered by touch or movement. The exact cause can be unknown, but the attacks are treatable.