Imagine having to experience excruciating, shock-like pain when you are brushing your teeth or washing your face. This experience is not uncommon for people who suffer from trigeminal neuralgia (TN). Trigeminal neuralgia is a condition that affects the trigeminal nerve which is responsible for motor functions such as chewing, biting, and swallowing as well as for carrying sensation from the face to the brain.

About Trigeminal Neuralgia

Trigeminal neuralgia (TN) is a chronic pain condition marked by acute spasmodic pain along the trigeminal nerve. It is characterized by severe, jabbing spasms that take place on the side of the face and last a few seconds at a time. The spasm starts out as a feeling of numbness or tingling that may be triggered by a slight touch to the face while shaving, applying makeup, brushing teeth, or washing. It may be followed by several bouts of similar, less intense shocks brought on by talking, eating, drinking or even a slight wind. Persons suffering from trigeminal neuralgia may have periods of remission which last for days, months, even years. During that time, they experience no pain at all.

Trigeminal neuralgia is caused by damage to the trigeminal nerve, which can occur when pressure from a blood vessel or tumor infringes upon the root of the nerve or when the outside sheath that protects the nerve is injured or destroyed. This commonly occurs in the final stages of multiple sclerosis, a progressive disease of the nervous system that results in the loss of myelin sheath surrounding nerve fibers.

Injury to the trigeminal nerve may also occur during facial or dental surgeries or as a result of infection. Trigeminal neuralgia is primarily found in women and those over the age of 50. In rare cases, it is passed down genetically.

Trigeminal neuralgia cannot be diagnosed by a single test. If facial pain is sudden, sharp and severe, a physician can determine if the trigeminal nerve is injured and, if so, which branch is affected. A facial examination or magnetic resonance image (MRI) can help to verify this.

Details about pain triggers such as touch, vibrations, drinking, eating, swallowing, brushing teeth, or the wind will also be helpful in the diagnosis. More specific tests may be necessary if the injury to the nerve is suspected to be caused by a tumor.

Trigeminal neuralgia is most often treated with medications that block signals being sent to the brain. Doctors may prescribe anticonvulsants (medicines that reduce the frequency of seizures), antispasmodics (medicines that minimize pain spasms), or antidepressants (medicines that reduce the sensitization to pain). However, over time, these medications may lose their effectiveness as patients develop a tolerance to them. Patients may also experience unpleasant side effects such as dizziness, double vision, sleepiness, nausea, confusion, or depression.

Several surgical procedures can alleviate severe pain but may not give long-lasting relief. Facial numbness, tingling, or muscle weakness are common side effects of surgery. Various surgical options include:

Alcohol Injection: Alcohol is injected in the area around the nerve to numb it.

Glycerin Injection: Glycerin is injected into the trigeminal nerve to block the pain signals.

Gamma Knife Radiosurgery (GKR): Gamma rays (high frequency electromagnetic radiation) are applied to the nerve to correct the trigeminal neuralgia. This procedure is done without anesthesia.

Microvascular Decompression (MVD): This procedure involves the removal of the blood vessel that is putting pressure on the trigeminal nerve. A surgical incision is made behind the ear to reach and remove the affected nerve, or a pad is placed between the trigeminal nerve and the blood vessel to relieve the pressure on the nerve.

Balloon Compression: A balloon is inserted through a catheter to the base of the trigeminal nerve and then inflated to relieve compression on the nerve and make it insensitive to pain signals.

Rhizotomy (severing of the nerve): The trigeminal nerve is partially severed at the base to incapacitate the nerve or a particular branch of the nerve.

Treatment options and selected medications vary by patient. The most severe cases often require a combination of medication and surgery.

Trigeminal neuralgia may affect daily life by hampering work productivity and your social interactions. Finding a support group may be your best resource, as it provides understanding and encouragement from others who can relate to the daily pain.