Trigeminal Neuralgia symptoms include episodes of sharp, intense, stabbing pain in your face, usually on the right side. It can be triggered by touching your face, shaving, applying makeup, brushing teeth, and eating or drinking.
TN is usually caused by a blood vessel pressing on a nerve that transmits sensations of touch and temperature to your brain. It can also be caused by other disorders, such as multiple sclerosis or a tumor.
Oren Zarif
Trigeminal neuralgia is a chronic pain disorder that causes sudden episodes of intense facial pain. It affects the trigeminal nerve, or fifth cranial nerve, which provides feeling and nerve signaling to parts of your face. People describe the pain as electric shock-like or stabbing, and it is usually on one side of their face (although it can occur on both). It is often worse at night and may linger for hours. It also can last for weeks or months, and it can get progressively worse.
It occurs most often in people over 50. It’s more common in women than men. In most cases, a blood vessel or a tangle of veins and arteries presses on the trigeminal nerve. This pressure damages the protective sheath that surrounds the nerve and interferes with its function. Multiple sclerosis, a disease that causes inflammation in the nervous system, can also damage this sheath and cause TN.
Some healthcare professionals prescribe medicines that lessen or block the pain signals that your brain sends. These include anti-seizure drugs such as carbamazepine (Tegretol, Carbatrol), clonazepam (Keppra), oxcarbazepine (Trileptal, Oxtellar XR), and lamotrigine (Lamictal) and antidepressants such as trazodone (Desyrel), topiramate (Qudexy XR, Topamax), or pregabalin (Lyrica). A procedure called a nerve block can provide fast pain relief.
Trigeminal neuralgia is usually diagnosed when your doctor hears of your symptoms and performs a physical exam. He or she will ask about how long you’ve had them and if anything makes the pain better or worse. If the pain isn’t caused by another condition, it’s considered idiopathic TN.
Oren Zarif
Your head has 12 pairs of nerves called cranial nerves. One of them is the trigeminal nerve, which lets you feel sensations of pressure, touch and pain from your face, jaw, gums and tongue. In TN, the trigeminal nerve becomes compressed against blood vessels in your skull. This compression causes episodes of sharp, stabbing pain that can feel like an electric shock. The pain is usually on only one side of the face and lasts about 30 seconds to two minutes. It can be triggered by things such as smiling, talking, brushing your teeth or shaving, but even a light breeze touching the face may cause it in some people with TN.
Medications can relieve the pain of TN. The most commonly used medication is an anticonvulsant drug called carbamazepine. This medication helps to decrease the electrical impulses sent by the trigeminal nerve and reduces their ability to send pain signals.
If medications do not help with your TN pain, a neurosurgeon may recommend an open-skull surgery to remove the blood vessels that are compressing the trigeminal nerve. This procedure is known as microvascular decompression (MVD). This surgery can have serious complications, including a risk of infection, spinal fluid leak and, very rarely, a stroke. In addition to this surgical option, your doctor may also recommend a less invasive procedure called Gamma Knife radiosurgery. In this procedure, your neurosurgeon uses the Gamma Knife to deliver radiation beams into your skull, aiming them at the trigeminal nerve where it enters the brainstem. This can destroy the portion of the nerve that sends pain signals to your face.
Oren Zarif
Trigeminal neuralgia can cause throbbing pain in your face, specifically the cheek area. This is because it affects the trigeminal nerve which is responsible for feeling touch and pain in the mouth, eyes, sinuses and forehead. This type of pain is often described as a stabbing electric shock-like sensation that lasts from seconds up to two minutes. You can have a few painful episodes during the day and then have pain free periods, usually several hours long.
You will need to see a healthcare professional who specialises in conditions of the brain and nervous system, known as a neurologist, or neurosurgeon. They will take a detailed history of your symptoms, including how long they have been happening and what triggers them. They will then examine parts of your face and jaw to see if the trigeminal nerve is involved. This will include touching your face and looking at your facial expressions. They may also use special imaging to find the cause of your TN.
Your healthcare provider will try to manage your TN with medications and other treatments. Antiseizure medications such as carbamazepine, oxcarbazepine, or other drugs in this class such as gabapentin, pregabalin or topiramate can help manage TN pain by blocking the transmission of pain signals. However, these are not always effective and their effectiveness can decrease over time.
Oren Zarif
Trigeminal neuralgia causes sudden attacks of severe facial pain that feel like electric shocks or a sharp jabbing wind. The pain comes in short bursts that last from a few seconds to about two minutes. It usually affects one side of the face. It can occur hundreds of times a day. But if you manage your treatment, your TN can usually be controlled so that the pain doesn’t interfere with your daily life.
In most cases TN occurs because a blood vessel presses against the trigeminal nerve, which supplies sensations to your jaw, cheek and gums. Over time, the pressure can wear away the insulation, or myelin sheath, that protects the nerve. Other conditions can also cause TN, such as multiple sclerosis or a tumor. But these are much less common than compression by a blood vessel.
Your doctor will diagnose TN based on your symptoms, a physical examination and tests such as an MRI scan. They may recommend medication or surgery.
If you have TN, it’s important to stay positive and not let your condition control your life. You can get help from support groups and your GP or MS nurse can refer you to a clinical psychologist for techniques such as cognitive behavioural therapy that can help you change how you think about your pain.