Severe Facial Pain from Trigeminal Neuralgia in Multiple Sclerosis

An Incapacitating, Stabbing Pain on the Side of Your Face

Trigeminal Neuralgia and MS
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Trigeminal neuralgia has to be one of the worst disorders that people with multiple sclerosis (MS) experience. 

This disorder entails a type of pain called “neurogenic pain” or “primary pain,” as it stems directly from the disease process of multiple sclerosis. In other words, demyelination (the loss of myelin around nerve fibers) is what triggers this disorder in people with MS.  

What Does Trigeminal Neuralgia Feel Like?

Trigeminal neuralgia, often called tic doloureux (French for “painful twitch”), is perhaps the most intensely painful MS-related symptom.

Here are some basic features of this disorder:

  • Occurs in the lower part of the face and almost always on one side, although may be bilateral (both sides) in about 10 percent of people with MS
  • Almost always occurs on just one side of the face (and is more common on the right than left side)
  • Intense, sharp pain, like an electrical jolt
  • Usually, the most intense pain is short-lived (from a few seconds to up to two minutes), but can result in a more constant burning or aching sensation

Interestingly, the pain of trigeminal neuralgia can extend as far as the ear, and sometimes be mistaken for the pain of an ear infection. Also, you may be surprised to learn that in addition to being triggered by talking, chewing, drinking, or brushing one's teeth, trigeminal neuralgia can be triggered by loud sounds or gusts of cold air.

Furthermore, more commonly than an ear infection, given the location and nature of the pain associated with trigeminal neuralgia, it's often mistaken for dental pain.

This can lead to unnecessary (and irreversible) procedures like tooth extractions, root canals, and even procedures to reposition the jaw.

This is why it's especially important to see your neurologist if you think you may be experiencing trigeminal neuralgia, especially before undergoing any kind of drastic dental work.

Finally, each “bout” or episode of trigeminal neuralgia usually lasts a couple of weeks. And episodes tend to recur and can happen as often as every couple of months, although some people will go years between episodes. Unfortunately too, as time passes, the time between bouts generally gets shorter.

How Common Is Trigeminal Neuralgia?

Trigeminal neuralgia is fairly rare, with only 4 percent of people with MS experiencing this kind of pain. However, people with MS are 400 times more likely than the general population to have an episode of trigeminal neuralgia. Also, it's interesting to note that trigeminal neuralgia tends to be one of the first symptoms of multiple sclerosis for those who experience it.

What Causes Trigeminal Neuralgia?

Trigeminal neuralgia is caused by lesions of the trigeminal nerve, which is also called the fifth cranial nerve. The 12 cranial nerves emerge directly from the brain instead of from the spinal cord, and the trigeminal nerve controls the muscles needed for chewing. The trigeminal nerve is also responsible for most facial sensation.

How Severe Does Trigeminal Neuralgia Get?

Trigeminal neuralgia can get so severe and distressing that it may require hospitalization and painkillers given through your vein (intravenous).

It can also interfere with a person’s drinking of fluids, so these sometimes have to be given intravenously as well. 

Aside from the physical distress trigeminal neuralgia causes, a person often experiences psychological distress. Many people have anxiety and fear about the possibility of it recurring which can cause significant suffering and interfere with daily life.

How Is Trigeminal Neuralgia Treated?

If you have trigeminal neuralgia, your doctor may prescribe either ​Tegretol  (carbamazepine) or Trileptal (oxcarbazepine) to ease symptoms. Other medications may include:

  • Baclofen
  • Lamictal (lamotrigine)
  • Botox injections

In addition to seeing your neurologist and taking medication (if needed), reaching out to a support group may also be beneficial for the psychological manifestations of trigeminal neuralgia.  Finally, some people do require surgery for their trigeminal neuralgia. 

A Word From Verywell

A final key point to make is that a person can develop trigeminal neuralgia without having multiple sclerosis. In this instance, there are changes in the trigeminal nerve root from vascular compression—so there is no MS lesion and no evidence of demyelination. This type of trigeminal neuralgia is called classical trigeminal neuralgia.

When trigeminal neuralgia is caused by MS, it's referred to as secondary trigeminal neuralgia. 

Sources:

Cruccu G. Trigeminal neuralgia. New classification and diagnostic grading for practice and research. Neurology. 2016 Jul 12;87(2):220-28.

Krafft RM. Trigeminal neuralgia. Am Fam Physician. 2008;77(9):1291-96.

Montano N, Conforti G, Di Bonaventura R, Meglio M, Fernandez E, Papacci F. Advances in diagnosis and treatment of trigeminal neuralgia. Ther Clin Risk Manag. 2015;11:289-99.

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