Trigeminal Neuralgia (facial pain)

What is trigeminal neuralgia?

Neuralgia is severe pain caused by injury or damage to a nerve.

• The trigeminal nerve supplies
• The forehead and eye.
• Sensation to the cheek, upper lip, and roof of the mouth.
• Sensation to the jaw and lower lip; it also provides movement of the muscles involved in biting, chewing, and swallowing.

When the trigeminal nerve is irritated, it causes a severe pain attack. Trigeminal neuralgia, also known as tic-douloureux because of the uncontrollable facial twitching caused by the pain, is a serious condition that interferes with many aspects of a person’s life. Trigeminal neuralgia is characterised by brief bursts of intense pain on one side of the face, similar to an electrical shock. This pain comes in waves that can last an hour or more. Initially, the patient may experience brief, mild attacks followed by periods of remission. However, trigeminal neuralgia can progress, resulting in longer, more frequent attacks of searing pain. 

Causes of Trigeminal Neuralgia:

1. Nerve Compression: Compression or irritation of the trigeminal nerve, often by blood vessels, leading to bouts of severe pain.
2. Aging: More prevalent in individuals over 50, trigeminal neuralgia may be associated with age-related changes.
3. Neurological Disorders: Conditions such as multiple sclerosis can contribute to trigeminal neuralgia.

Signs and Symptoms: Recognizing the distinctive signs and symptoms of trigeminal neuralgia is vital for prompt intervention:

1. Intense Facial Pain: Sudden, severe, stabbing pain on one side of the face, typically around the eyes, nose, or jaw.
2. Trigger Factors: Pain triggered by seemingly harmless activities like chewing, talking, or even a gentle touch to the face.
3. Episodic Nature: Pain occurs in episodes, with periods of remission between attacks.

Diagnosis: Accurate diagnosis is crucial for tailoring appropriate interventions. Common diagnostic approaches include:

1. Clinical Evaluation: Thorough examination by a neurologist or pain specialist to assess symptoms and medical history.
2. Imaging Studies: MRI scans may be conducted to rule out other potential causes of facial pain.
3. Neurological Testing: Assessing the function of the trigeminal nerve to confirm the diagnosis.

Treatment/Management: Effective management of trigeminal neuralgia involves a multi-faceted approach:

1. Medications: Anticonvulsant medications and tricyclic antidepressants to manage pain and prevent episodes.
2. Nerve Blocks: Local anesthetic injections to numb the trigeminal nerve and alleviate pain.
3. Surgical Options: Microvascular decompression or stereotactic radiosurgery for cases resistant to medication.
4. Botox Injections: Botulinum toxin injections may provide relief by relaxing facial muscles.