Trigeminal Neuralgia by Dr. Khawaja S. Nasir

What is trigeminal neuralgia?

It is a chronic debilitating painful condition that affects the main nerve (trigeminal nerve) that carries sensation from your face to your brain. It consists of episodes of sudden, severe, stabbing pain that occur for few seconds and are distributed across one side of the face. The pain is described by the patients as an “electric shock”, which may be severe enough to incapacitate them.

How common is trigeminal neuralgia?

Trigeminal neuralgia is a rare condition. It is estimated to affect nearly 12 individuals per 100,000 people. It takes place usually after age of 50 and can affect both men and women. However, it is more common in females.

How can I tell if I have trigeminal neuralgia?

An episode of trigeminal neuralgia may present as a jolt of excruciating electric pain that is limited to only one side of your face. The episode is short-lived and rarely lasts for more than 2 minutes. It can be a single episode or a series of episodes with short-intervals in between. Pain is often triggered after a mild harmless provocation, such as talking, smiling, brushing teeth, washing face, or even gentle breeze blowing against the skin.

During an active phase, episodes of trigeminal neuralgia may continue to take place daily for days, weeks or months. Similarly there may sometimes be a period of remission, during which pain may disappear and not return for several weeks, months or years.

What causes trigeminal neuralgia?

The exact cause of trigeminal neuralgia is not known. However, in most of the cases, it is believed to be due to compression of the trigeminal nerve from an adjacent blood vessel. These are normal blood vessels that are present along the route of the nerve as it branches out of the brain, and are normally present in the region. Currently, it is not clear why this pressure may result in development of trigeminal neuralgia in some people and not everyone else.

Similarly, trigeminal neuralgia may take place secondary to an underlying disease or disorder, such as a tumor, multiple sclerosis, or a malformation of blood vessels. Contrarily, in some patients there may be no apparent identifiable cause for trigeminal neuralgia.

Can trigeminal neuralgia be treated?  

There are no absolute cures available for trigeminal neuralgia. However, a number of treatments can offer relief from pain associated with trigeminal neuralgia.

The first form of treatment is usually medications. There are multiple types of specialized medications available that relieve pain and stop additional episodes of trigeminal neuralgia. Such medications have to be taken every day during the active phase of the condition. However, once the frequency or intensity of episodes wanes away, the use of medications can be decreased or stopped.

Likewise, there are multiple types of injections that can provide short and long-term relief from symptoms. They can be used alone or in combination with medication therapy.

Lastly, there are multiple types of surgical options that can be considered. These consist of procedures that deliberately damage or injure the nerve, or reposition the blood vessel compressing the nerve. For patients that have limited relief from medications, or cannot tolerate the medications, surgical options can provide long-term relief from trigeminal neuralgia related symptoms.

Overall, there are numerous types of treatments available that may help you in treating trigeminal neuralgia. The correct choice of treatment depends on the underlying cause of the neuralgia and your general medical health. Not everyone responds to these treatment options in the same way. However, together with your doctor you should be able to find ways to treat your nerve pain.

When should I seek help? 

If you experience facial pain, particularly brief jabs of sudden excruciating electric pain that is not relieved by use of regular pain relievers, you should see a doctor.

What kind of doctor should I see?

A Pain Medicine or an Orofacial Pain specialist or a Neurologist with formal training in in evaluating and managing painful head and neck conditions can provide you with the appropriate care that you need to manage such painful conditions. If necessary, they may refer you to an Oral and Maxillofacial Surgeon or a Neurosurgeon for further care.

Dr. Khawaja Shehryar Nasir is a diplomat of American board of Orofacial Pain. He is currently practicing as an Orofacial Pain and Headache Medicine Consultant in Shaukat Khanum Memorial Cancer Hospital and Research Centre. You can now book an appointment with him through oladoc.com for your head, face, jaw and neck pain management related needs.