What is this unbearable facial pain? (Trigeminal Neuralgia)

Have you ever had an unbearable pain on one side of your face, like an electric shock, when you brush your teeth, eat, or even just smile? This pain, which comes and goes for a few seconds, can be so severe that you can't even do your daily activities. It can be a life-threatening experience. That's the condition we're talking about today, Trigeminal Neuralgia.

What is Trigeminal Neuralgia?

Simply put, this is nerve pain in your face. To be precise, it is neuropathic pain. There is a main nerve that carries sensation from our head to our face, called the trigeminal nerve. This nerve acts like a main 'wire' that carries sensation to our face and head. This pain occurs when something puts pressure on this nerve near the brainstem.

What often happens is that a blood vessel near where this nerve enters the brain presses on the nerve. Then the nerve becomes 'shorted' and sends severe pain signals to the brain for no apparent reason.

How does this pain feel? What are the symptoms?

The main symptom is a sudden, unbearable, severe pain on one side of the face. This pain can be felt in different ways.

• Feeling like you're being struck by lightning
• A sharp pain like a knife
• When pain strikes , the muscles in the face may tense up automatically .

Even in the intervals between these severe pain episodes, some people may experience other facial discomfort.

• Burning sensation
• Feeling like something is throbbing (Throbbing)
• Numbness of the face
• Dull, constant pain (Dull achiness)

Depending on how these symptoms occur, trigeminal neuralgia can be divided into two main types.

Most of the time, this pain only affects one side of the face. However, very rarely, it can affect both sides of the face (but not both sides at the same time). For some people, the condition may gradually worsen over time, and the pain may increase in frequency.

Triggers that increase pain

Imagine, the most ordinary things you do in your daily life can be the cause of this terrible pain. This is the saddest part of this disease.

• Shaving, putting on makeup, or washing your face
• Eating and drinking water/beverages
• Brushing teeth, rinsing mouth
• Talking, laughing
• Slight tightening of the face, especially the cheek or jaw area
• A slight breeze hits the face.

The best thing is that this pain usually doesn't occur during sleep.

Why does this happen? What are the reasons?

It usually occurs when there is pressure or damage to the trigeminal nerve. Doctors classify this condition based on this cause.

Who is most at risk of developing this condition?

• Having high blood pressure
• Smoking
• Over 50 years of age
• Being a woman (women are more likely to have this)
• Someone in the family has this disease

Doctor, how do you diagnose this?

When you go to see a doctor, he or she will first ask you about your symptoms and medical history. Then, they will examine your head and neck area and perform a neurological exam. The diagnosis often depends on the information you provide.

• The nature of the pain you feel (like an electric shock? Like stabbing with a knife?)
• The exact location of the face where the pain is felt
• What kind of things do you do that start the pain?

To find the exact cause, such as whether a blood vessel is blocked or if there is something like a tumor, you may be asked to have an MRI scan .

What are the treatments for this?

Fortunately, there are several treatments available to help manage this severe pain. It may take some time to find the treatment that works best for you.

Medications

Often, the doctor first recommends medications.

• Antiseizure medications: These medications work by blocking the transmission of pain signals to the brain. Treatment usually begins with medications called `Carbamazepine` or `Oxcarbazepine`. Although these are very effective in the beginning, their effectiveness may decrease over time. Other medications such as `Gabapentin`, `Pregabalin`, `Lamotrigine` are also used.
• Baclofen: This is a muscle relaxant.

Each of these medications can have some side effects, so you and your doctor should work together to choose the best medication for you.

Surgery

Surgery is usually considered in cases like these:

• If the pain cannot be controlled with medication.
• If there is a secondary TN condition (e.g., a tumor).

There are different types of surgeries, and their risks and outcomes are also different.

• Microvascular decompression: This is the most successful surgery. It involves surgically removing the blood vessel that is pressing on the nerve and inserting a small 'pad' between it.
• Radiosurgery: This involves directing a beam of radiation at the nerve root to block pain signals. It can take about a month to see results.
• Rhizotomy: This involves intentionally damaging the nerve root to stop pain signals. This can be done in several ways. However, it almost always leaves some numbness in the face.

Other treatments

Along with medication, other things can help control pain.

• Botulinum toxin injections or nerve blocks provide temporary relief.
• Acupuncture
• Biofeedback
• Psychotherapy
• Yoga and Meditation

What other problems can this cause?

The pain of trigeminal neuralgia can be so severe that it can have a major impact on your mental health and daily life. People with the condition may experience:

• Depression
• Anxiety
• Social isolation

Also, complications can occur from treatments. For example, long-term use of anti-seizure medications can lead to bone thinning (osteoporosis). Surgery can also cause permanent facial numbness.

When should I see a doctor?

No one wants to live with constant, severe pain. If you experience severe facial pain, see a doctor immediately. If you have been diagnosed with this condition, it is important to see your doctor regularly to make sure your treatment plan is working.