Trigeminal Neuralgia

A condition called trigeminal neuralgia causes severe facial pain. This painful syndrome is also sometimes referred to as tic douloureux.

Trigeminal neuralgia is characterized by extreme sensitivity to touch on part of the face or severe facial pain even when the face is not being touched. It occurs in healthy adults, and is one of the most common types of facial pain.

The Symptoms Of Trigeminal Neuralgia

Normally, trigeminal neuralgia affects one side of the face, and may cause pain of the whole side of the face or of just the upper, middle or lower part of the face.

Trigeminal neuralgia causes a throbbing, burning pain. The pain may be constant, or it can come and go. It can even quiet down for months and then flare up again. Most of the time, if the pain is not treated by medication or surgery, there will be some constant facial pain in the background even when it isn't flaring up. 

Usually, the skin around the painful area has a normal appearance. Occasionally, people with trigeminal neuralgia may notice a subtle swelling or redness of the painful area, but most of the time, there is no visible problem.

Causes Of Trigeminal Neuralgia

Trigeminal neuralgia can be triggered by irritation of the facial nerve, and has been known to begin after dental work or surgery in the facial area. However, more often than not, there is no explanation for why someone gets trigeminal neuralgia. 

There are rare instances in which there is a serious underlying cause of the pain- such as a brain tumor or a brain aneurysm.

Your doctor will look for those causes and rule them out before giving you a diagnosis of trigeminal neuralgia.

Treatment of Trigeminal Neuralgia

There are several medical treatments for the pain, including over the counter painkillers and prescription medications that are normally used for nerve pain.

The most commonly prescribed of these medications include carbamazepine and gabapentine, which are known as anti-seizure medications. When used for trigeminal neuralgia, these medications are used to 'calm down' the nerve activity to reduce the pain. Creams that contain painkillers are popular among people who suffer from trigeminal neuralgia, but are not usually helpful for the most severe pain. Nevertheless, creams are safe to use as long as they don't get into your eyes or ears, and some people do notice improvement with creams. 

Surgery can also help reduce or eliminate the pain of trigeminal neuralgia. In trigeminal nerve surgery, the trigeminal nerve or a portion of the trigeminal nerve is deliberately cut to get rid of the pain. Often, after surgery for trigeminal neuralgia, the normal sensation of the face is reduced or lost, but in cases of severe pain, most people with trigeminal neuralgia think it is worth it.

Social Aspects Of Trigeminal Neuralgia

Often, individuals who have trigeminal neuralgia may feel emotionally exhausted or moody due to the persistent, relentless pain. Depending on your situation, it may be worthwhile to discuss your condition with family members, close friends or even trusted coworkers so that they would not interpret your behavior as standoffish or rude.

The Trigeminal Nerve

Each side of your face obtains its sensory function through a nerve called the trigeminal nerve. Trigeminal neuralgia is caused by damage or irritation of the trigeminal nerve, and this is what gives the condition its name.

Each side of the face has its own trigeminal nerve. And each trigeminal nerve has three branches:

  • Ophthalmic, upper branch: Controls sensation of the the scalp and forehead
  • Maxillary, middle branch: Controls sensation of the cheek, nose, upper lips, upper teeth, upper gums and upper jaw
  • Mandibular, lower branch: Controls sensation of the lower lips, lower jaw, lower teeth and lower gums

    One, two or all three branches of the trigeminal nerve may be involved in trigeminal neuralgia.

    A Word From Verywell

    Trigeminal neuralgia is a very distressing and painful condition. However, it is not life threatening, and it does not put you at risk of developing a serious medical disease.

    Living with trigeminal neuralgia is difficult. The management is focused on achieving pain control without experiencing side effects that interfere with daily life.

    Over time, most trigeminal neuralgia pain improves on its own, allowing reduction of the pain medication, or even complete discontinuation of the medication. However, it is difficult to predict how long it will take for the pain to improve on its own. Therefore, most people with trigeminal neuralgia feel that it is worthwhile to get medical attention and pain management while the condition is at its worst.

    Further Reading:

    Trigeminal Neuralgia, Glossopharyngeal Neuralgia, and Myofascial Pain Dysfunction Syndrome: An Update, Pain Res Manag. 2017;2017:7438326.

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