Do you sometimes experience an unimaginable, severe pain on one side of your face? Is it a sharp pain like an electric shock, or someone stabbing you with a knife? Or does this pain occur even when you laugh, talk, or eat? Then this may be very important to you. Today, we will talk about a condition called Trigeminal Neuralgia.
What is Trigeminal Neuralgia?
Simply put, trigeminal neuralgia is a very severe, unbearable pain that occurs on one side of your face, from time to time. This usually happens when a blood vessel in your brainstem, called the trigeminal nerve , is compressed. Think about it, this trigeminal nerve is the main nerve that brings sensation to our head and face. It's like the sensor in our face. So when there is pressure on this nerve, the signals coming from it are disrupted, resulting in this severe pain. This is considered nerve-related pain.
This is not a life-threatening disease, but it can be life-changing . Just think, many people are depressed because of this severe pain that comes for seconds or minutes even when doing very ordinary things like eating, talking, laughing, or brushing their teeth. This is usually a long-term `(Chronic)` condition. But don't worry, there are several treatments that can help control these symptoms.
Some people also call this 'tic douloureux', which is another name for the same disease.
How common is this condition?
Although there are no exact statistics in Sri Lanka, according to data from some countries in the world, about one and a half million people are diagnosed with this disease every year. Women are more likely to develop this disease than men . Also, it is most common after the age of 50. This condition is very rare in young children.
What are the symptoms of Trigeminal Neuralgia?
The main symptom is a sudden, severe pain in the face . Most often, this occurs on only one side of the face. The pain can come in many different forms:
- It may feel like you've been struck by lightning .
- There may be a sharp pain , like a stab .
- When the pain comes, it may feel like the muscles in your face are twitching .
During the pain-free period, you may feel things like:
- Like a burn .
- A thud like a slap .
- Numbness .
- A slow, dull pain .
There are two types of pain depending on how it occurs:
1. Paroxysmal TN: This is a sudden, severe, sharp pain . This pain can last from a few seconds to about two minutes, sometimes accompanied by a burning sensation in the face. Although there are periods of time between when the pain subsides, the pain can come and go for about two hours. Imagine, like Niluka, when she opens her mouth to eat, she starts with a thin line on the right side of her face, and within a few seconds, unbearable pain comes on, subsides after a while, and then comes back when she tries to eat.
2. Continuous pain (TN with continuous pain / Atypical TN): In this type, the pain is not as sharp as the above, but there is a constant pain . There may be a stabbing, burning sensation, and a slight ache. In this atypical (atypical) trigeminal neuralgia condition, it can be a little difficult to control the symptoms.
Trigeminal neuralgia is usually a ``unilateral`` condition that affects only one side of the face. Very rarely, it can affect both sides of the face (bilateral), but not both at the same time. In some cases, over time, the pain may increase in frequency, last longer, and worsen.
What are the things that increase this pain (`Triggers`)?
Often, this painful condition is triggered by very simple, everyday things, such as moving your face or touching your face. For example:
- When shaving, putting on makeup, washing your face.
- When eating food, when drinking water.
- When brushing your teeth, when rinsing your mouth.
- When talking, when laughing.
- If there is any pressure on the face, especially on the cheek or jaw area.
- Even a gust of wind in the face (think of the wind coming through the window of a bus) can cause pain.
But surprisingly, this pain occurs very rarely when you are sleeping .
Why does trigeminal neuralgia occur? What are the causes?
Generally, it is caused by pressure or damage to the trigeminal nerve. Doctors classify it according to its cause:
Three types according to causes:
1. Primary (classic) TN: This is caused by a blood vessel (usually the superior cerebellar artery) pressing on the trigeminal nerve root (nerve compression). This is the cause of most cases .
2. Secondary TN: This occurs when the trigeminal nerve is damaged by another condition. For example, a disease like Multiple Sclerosis (MS), a brain tumor, or an arteriovenous malformation. People with secondary TN are usually younger, and the pain may be on both sides of the face. This type accounts for about 15% of all TN patients.
3. Idiopathic TN: Sometimes, despite extensive testing, no clear cause can be found for facial pain. This is when doctors call it idiopathic TN.
Who is at higher risk of developing this? (Risk Factors)
There are several risk factors that contribute to the development of this condition:
- High blood pressure .
- Smoking .
- Aging .
- Being the female side .
- Having a family member with this disease (genetic influence).
How does a doctor diagnose trigeminal neuralgia?
First, your doctor will ask you about your symptoms and medical history. Then they will examine your head and neck, and perform a neurological exam. Often, the diagnosis is made by considering several factors:
- The nature of the pain you feel (like an electric shock or stabbing pain?).
- The exact spot on the face where the pain is felt .
- What kind of things cause pain ?
Since there are many other diseases where facial pain is a major symptom (e.g. cluster headaches, migraines, postherpetic neuralgia, TMJ dysfunction), a doctor will have to rule out those diseases as well.
Your doctor may order a brain MRI scan to help determine exactly what's causing the pain – whether it's a blood vessel pressing on your brain or something like a tumor.
What are the treatments for trigeminal neuralgia?
Doctors use a combination of medications, surgery, and other treatments to treat trigeminal neuralgia. It may take some time to find the right treatment for you.
Medications:
In most cases, for primary (classic) and idiopathic TN conditions, the first thing doctors suggest is medication.
- Antiseizure medications: These medications block pain signals. Doctors often start with carbamazepine or oxcarbazepine. These help control pain in many people in the early stages of T.N. But these medications can become less effective over time. Other medications in this group include gabapentin, pregabalin, lamotrigine, lacosamide, topiramate, and phenytoin.
- 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 medication that is best for you.
Surgery:
Doctors only consider surgery in these cases:
- If symptoms cannot be controlled with medication.
- If you have a secondary TN condition (e.g., a tumor pressing on a nerve).
The complexity, risks, and side effects of surgery for TN vary. Your doctor will explain all of this to you. Some of the surgical options for TN include:
- Microvascular decompression: This surgery relieves pressure from the blood vessels that are compressing the trigeminal nerve. This is the most complex surgery for TN. However, it is also the most effective way to prevent pain in the long term.
- Radiosurgery: In this procedure, a beam of radiation is directed at the root of the trigeminal nerve to block pain signals. This can take about a month to reduce pain.
- Rhizotomy: In this procedure, the root of the trigeminal nerve is deliberately damaged to block pain signals. There are several ways to do this. For example, mechanical balloon compression, thermocoagulation, and chemical injection. This procedure always causes some degree of facial numbness and loss of sensation. Although it can reduce pain for a few years, long-term success is limited.
- Peripheral neurectomy: This involves damaging or removing a peripheral branch of the trigeminal nerve. This can be done by alcohol injection, incision, cryotherapy, or radiofrequency lesioning.
Other Treatments:
Your doctor may also suggest other treatments to help control the pain of trigeminal neuralgia - usually in addition to medication. These include:
- Botulinum toxin injections or nerve blocks provide temporary pain relief.
- Acupuncture .
- Biofeedback .
- Psychotherapy (talk therapy) `(Psychotherapy)` .
- Yoga .
- Meditation .
- Aromatherapy .
What does someone with trigeminal neuralgia experience?
This doesn't affect everyone the same, so it's hard to say exactly how it will affect you. Some people may have periods of pain that last for weeks or months, followed by periods of no pain. Others may have ongoing facial pain along with their attacks. For some, their attacks get worse over time. Also, the medications used to treat TN can become less effective over time.
For all of these reasons, it's important to talk to your doctor regularly to see how your TN is affecting you and whether your treatment plan is working. You don't want to continue to be in pain.
What are the complications of this condition?
The pain of trigeminal neuralgia can be so severe that it can have a significant impact on your mental health and daily life . People with TN are at risk for developing conditions such as:
- Depression .
- Anxiety .
- Social isolation .
If this condition is affecting your mental health, it's important to seek professional help . Talk to your doctor or a mental health counselor, such as a psychologist.
Treatments for TN can also cause complications. Long-term use of epilepsy medications can lead to problems like osteoporosis. Surgery can also cause complications like permanent facial numbness.
When should I see a doctor?
No one wants to live with frequent attacks of pain. If you have severe facial pain, be sure to see a doctor . If you are diagnosed with TN, you will need to see a doctor regularly to make sure your treatment plan is working.
What questions should you ask the doctor?
It may be helpful to ask your doctor these questions about trigeminal neuralgia:
- Why did I develop trigeminal neuralgia?
- What type of TN do I have?
- What can I do to reduce the pain I feel when I touch or shake my face?
- What treatment options do I have?
- What are the advantages and disadvantages of each of those treatment options?
- Are there support groups for people with trigeminal neuralgia?
Finally, things to remember (Take-Home Message)
Although trigeminal neuralgia is a physical condition, it can also have a huge impact on your mental and emotional health. You may be afraid to do normal things or go out in public because you're afraid of having a severe attack. But the good news is that there are several treatment options that can help you live your life the way you want. While this may be a condition that you'll have to live with for the rest of your life, remember that it can be managed. You're not alone, and there are ways to get help.
` Trigeminal neuralgia, facial pain, nerve pain, pain management, cranial nerves, facial pain
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