Trigeminal neuralgia: When your face is on fire

What’s the worst pain you’ve ever felt? Kidney stones? Childbirth?

For the 45,000 people in the United States who live with trigeminal neuralgia (also known as tic douloureaux), the answer is clear: The pain of trigeminal neuralgia trumps everything else. This type of pain is a severe, stabbing pain on one side of the face, stemming from one or more branches of the nerve that supplies sensation to the face.

According to some sufferers:

 

The pain never lets up.

Sometimes it feels like I have electric shocks traveling down my face.

 

Trigeminal neuralgia affects more women than men, with most (but not all) cases appearing after the age of 50. And for some people, the pain is inherited – some experts think that there might be a genetic link that causes trigeminal neuralgia to run in specific families.

 

Trigeminal neuralgia changes the lives of the people who have it. But the searing quality of the pain is only half of the story: Trigeminal neuralgia also leads many people to stay at home, rather than face random, agonizing, painful attacks in public.

The pain that won’t let go

There are many different ways for that people describe pain associated with trigeminal neuralgia: It could feel like an electric shock, a shooting or sharp stabbing pain, a burning sensation, or any other sudden and extreme sensitivity in parts of the face. In some cases, the pain of trigeminal neuralgia may give warnings in advance, by causing facial tingling or numbness.

 

The sudden pain of trigeminal neuralgia may start with simple actions, like tooth brushing, eating, shaving, or even facing into the wind. Most attacks happen on one side of the face only, lasting from seconds to minutes. For some unlucky people, though, the searing pain may repeat up to 100 or more times per day. These episodes may keep going for days, weeks, or months, only to stop and return at a later date. Future attacks often take place closer together, with fewer pain-free periods.

The story behind the pain

There are two trigeminal nerves: one on each side of the face. Each nerve has three branches that sense pain and touch on different parts of the face, sending those messages to the brain.

  • The upper branch of the trigeminal nerve covers the scalp, the forehead, the eye, and the front of the head.
  • The middle branch handles feelings in the cheeks, upper jaw, top lip, upper teeth and gums, and side of the nose.
  • The lower branch senses problems in the lower jaw, lower teeth and gums, bottom lip, and outer ear.

When a trigeminal nerve is damaged in one or more of its branches, it starts to send pain signals that are overblown, or just plain wrong. Some of this nerve damage may be caused by a blood vessel that rubs or pushes against part of the trigeminal nerve: This constant motion can wear away the nerve’s protective cover, sending abnormal pain signals to the brain. The nerve may also be damaged if a person has multiple sclerosis (which wears away nerve coatings), or if a tumor is pressing on a particular branch. Other causes can include facial injuries, dental procedures, or problems from face or neck surgery.

What can be done?

Treatment for trigeminal neuralgia ranges from drugs, to surgery and complementary methods like acupuncture and biofeedback. Anti-seizure drugs like carbamazepine and gabapentin, though, are often the first choice. Other options include migraine medicines and tricyclic antidepressants. Over-the-counter pain relievers rarely control the pain to a satisfactory degree.

 

Physical Interventions

 

If none of these other treatments work, then interventions that relieve pressure on the trigeminal nerve, or that permanently damage the nerve on purpose, may help to control the pain. Once a nerve is destroyed, though, there’s no turning back, so this can be an especially tough choice. There are also no guarantees that the pain won’t return at some point after surgery. Keep in mind that many types of surgery may cause temporary or permanent facial numbness and/or paralysis; microvascular decompression (MVD) is the least likely to cause these problems, though.

  • Microvascular decompression (MVD) is a surgical procedure that separates the trigeminal nerve from any blood vessels that it touches, and could be potentially irritating it.
  • Glycerol injection around the trigeminal nerve causes permanent damage to the nerve, stopping pain signals.
  • Balloon compression damages the trigeminal nerve by pushing it against the skull. It may cause weakness of the chewing muscles.
  • Electric current damages trigeminal nerve fibers by applying heat.
  • Cutting the trigeminal nerve relieves pain by causing permanent facial numbness.
  • Focused, high-dose radiation to the trigeminal nerve is a new, painless procedure that may take weeks to relieve pain. Long-term side effects aren’t yet known.

Don’t suffer alone

Trigeminal neuralgia can be very difficult to treat, but don’t give up hope or suffer alone. Work with your healthcare provider and leave no stone unturned while seeking relief.

References

National Institutes of Health
http://www.ninds.nih.gov   (search on “trigeminal neuralgia”)

 

Trigeminal Neuralgia Association
http://www.endthepain.org

 

Mayo Clinic
http://www.mayoclinic.com   (search on “trigeminal neuralgia”)

 

MedlinePlus
http://www.nlm.nih.gov    (search on “trigeminal neuralgia”)

 

Healthfinder.gov
http://healthfinder.gov   (search on “trigeminal neuralgia”)