What Is Trigeminal Neuralgia?

 

Trigeminal neuralgia is an ongoing pain condition that affects certain nerves in your face. You might also hear it called “tic douloureux.”

People who have this condition say the pain might feel like an electric shock, and it can sometimes be intense.

Doctors have treatments that can help, including medicine and surgery.

Mapping the Nerves in Your Face

To learn about trigeminal neuralgia, it helps to know a little about how the affected nerves are laid out.

In your head you have 12 pairs of what are called cranial nerves. The trigeminal nerves are among these pairs, and they let you feel sensations in your face. One nerve runs down each side of your head.

Each trigeminal nerve splits into three branches, controlling the feeling for different parts of your face. They are:

  • The ophthalmic branch. It controls your eye, upper eyelid, and forehead.
  • The maxillary branch. This affects your lower eyelid, cheek, nostril, upper lip, and upper gum.
  • The mandibular branch. It runs your jaw, lower lip, lower gum, and some muscles you use for chewing.

The disorder can affect any of the three nerve branches, meaning you could feel pain from your forehead to your jaw. Usually, you’ll feel pain on only one side of your face. Some people feel it on both sides. When that happens, it’s called bilateral trigeminal neuralgia.

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Symptoms

You may feel as though your pain came out of nowhere. Some people with this condition start out thinking they have an abscessed tooth and go to a dentist.

You may have these symptoms:

  • You have brief periods of stabbing or shooting pain.
  • The pain is triggered by things such as brushing your teeth, washing your face, shaving, or putting on makeup. Even a light breeze against your face might set off your pain.
  • It lasts a few seconds to several minutes.
  • The attacks happen several times a day or a week, followed by periods during which you have none at all. These pain-free periods are known as remission.
  • The pain affects only one side of the face.
  • The attacks happen more often over time, and the pain is worse.
  • You feel the pain mostly in your cheek, jaw, teeth, gums, and lips. The eyes and forehead are affected less often.

Doctors considers sudden and intense bouts of pain to be signs of “classic” trigeminal neuralgia. If your pain is less intense but constant -- more of an aching, burning sensation -- you might have what’s known as “atypical” trigeminal neuralgia.

Some people with this condition also have anxiety because they are uncertain when the pain will return.

What Causes It?

This starts with irritation of the trigeminal nerve. You might have a blood vessel pressing on the nerve, damaging the protective coating around it, which is called the myelin sheath.

Certain diseases, such as multiple sclerosis, also can injure the myelin sheath. Sometimes a tumor or a tangle of arteries presses on the nerve.

Your trigeminal nerve can also be injured -- perhaps by surgery, an accident, or a stroke.

Who Is More Likely to Get It?

Women are more likely than men to get trigeminal neuralgia, and the disease is more common in people older than 50. The disorder may run in families, perhaps because of how blood vessels are formed in the brain. It may also be linked to high blood pressure.

Although the pain can be intense, the condition is not life-threatening. It can be a progressive disease, though, meaning that it gets worse over time.

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Diagnosis

If you have facial pain -- especially sensations that keep coming back or don’t respond to over-the-counter pain relievers -- make an appointment with your doctor.

Be ready to tell your doctor about how your pain first appeared, how often you feel it, and what seems to trigger it.

Expect your doctor to ask lots of questions about your condition. You may also have a neurological exam, in which your doctor touches various parts of your face. He can test your reflexes to figure out whether a nerve is compressed.

An imaging test such as an MRI can show if a tumor or multiple sclerosis is an underlying cause of your problem.

Treatments

You have options to deal with this condition, including medication and surgery.

Medication: Your doctor may prescribe medicines that keep the nerves from reacting to irritation. These drugs are called anticonvulsants.

You also may take muscle relaxants -- alone or along with anticonvulsants. Typical pain medications don’t work well for people with trigeminal neuralgia, so your doctor may suggest a tricyclic antidepressant to manage your symptoms.

Surgery: Over time, your medication may help you less and less. That’s common among people with trigeminal neuralgia. If that happens, you have several surgical options.

Some of these procedures are outpatient, meaning they do not require you to be admitted a hospital. Some require general anesthesia, which means you won’t be awake during the surgery.

Your doctor can help you decide which surgery is right for you, based on your overall health, which nerves are involved, and your preferences.

Procedures include:

  • Microvascular decompression, which moves or takes out blood vessels that are affecting the nerve.
  • Gamma knife radiosurgery, which uses radiation focused on your trigeminal nerve.
  • Rhizotomy, which destroys nerve fibers. Doctors have several ways to do this.

Self-Care Ideas

You can explore alternatives ways to help you manage the symptoms of trigeminal neuralgia. These are some you want to try:

  • Acupuncture (a Chinese tradition that uses very thin needles to balance the flow of energy in your body)
  • Aromatherapy (the use of plant oils such as peppermint, lavender, etc., to help healing)
  • Meditation
  • Yoga
WebMD Medical Reference Reviewed by David Kiefer, MD on March 21, 2016

Sources

SOURCES:
Mayo Clinic: “Diseases and Conditions -- Trigeminal Neuralgia.”

American Association of Neurological Surgeons: “Conditions and Treatments -- Trigeminal Neuralgia.”

TNA Facial Pain Association: “What Is Trigeminal Neuralgia?”

New York Presbyterian Hospital: “Health Library -- Trigeminal Neuralgia.”

National Institute of Neurological Disorders and Stroke: “Trigeminal Neuralgia Fact Sheet.”

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