Trigeminal Neuralgia: The unbearable facial pain

Jul 14, 2019 Dr Zulfikar Bux, Features / Columnists

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By Dr Zulfikar Bux

Assistant Professor of Emergency Medicine

Trigeminal neuralgia is extreme burning, electric or shock-like pain in the face. The pain can be so extreme that it can get in the way of normal activity. Even the fear of oncoming attacks can be so stressful that performing day-to-day tasks is a challenge. The pain may last a few seconds or minutes, then ease and then recur. Usually, these cycles of pain occur for a few days or weeks, and then stop for days, weeks or even years before returning.
Over time, the cycles tend to recur more quickly, with shorter breaks in between. The pain sometimes is triggered by very normal activities, such as chewing, smiling, talking, shaving or brushing your teeth. At times, even the wind on your face can cause pain to start. It can get so intense and unbearable to the point where patients want to take their lives. While there are treatment options, it can take a while for your doctor to work with you to figure out the best option.
Today we will delve into this condition and the options that you may have.

WHAT CAUSES TRIGEMINAL NEURALGIA?
Trigeminal neuralgia occurs when the trigeminal nerve is pinched or damaged. The trigeminal nerve connects many different parts of your face to your brain. It is made up of three branches. The upper branch links the brain to the scalp and forehead. The middle branch connects to the cheek, side of the nose, top lip, and upper jaw, teeth and gums. The lower branch travels through the lower jaw, teeth, gums, and bottom lip.
Often, the damaged area of the nerve is located at the base of the brain where the nerve leaves the skull and extends to parts of the face. The nerve may be damaged from a blood vessel that grows too close and presses on the nerve or wears away the nerve’s protective coating. Damage to the nerve can also result when extra pressure is put on the nerve by something else, such as a tumor. In many cases, a cause of the nerve damage cannot be found.
WHO IS AT RISK FOR TRIGEMINAL NEURALGIA?
Anyone can get trigeminal neuralgia, but it happens most often in people older than 50 years of age. It’s also more common in people who have multiple sclerosis, because multiple sclerosis damages the myelin that protects the nerves. Women are more likely to get it than men, and the condition seems to be passed down in families, probably because relatives’ blood vessels form in similar ways.

WHAT TESTS CAN HELP DIAGNOSE TRIGEMINAL NEURALGIA?
No one specific test can confirm you have trigeminal neuralgia. Often, the diagnosis is made by ruling out other possible causes of your pain. Your doctor may try to pinpoint the cause by asking you questions about your symptoms and medical history. You may be checked for other things that could be causing your pain, such as jaw, sinus or tooth problems.
A type of brain scan called magnetic resonance imaging (MRI) may be done to see if a blood vessel is pressing against your trigeminal nerve. An MRI can also look for signs of a tumour or other problems.
HOW IS TRIGEMINAL NEURALGIA TREATED?
Trigeminal neuralgia can be treated in many different ways. As with many disorders, some treatments will work well for some people and less so for others. Don’t get discouraged if the first treatment you try doesn’t work. Let your doctor know how you are doing and ask about other options.
Your doctor may prescribe an anticonvulsant, antiseizure (medications used to treat fits) or antispasmodic drug. These medicines change how nerves transmit information, or how the nerves “fire.” That is why they can help with the pain caused by trigeminal neuralgia. Certain types of antidepressants can also be useful in the treatment of pain associated with trigeminal neuralgia. Antidepressants alter the chemical action in your brain that leads to sensing pain.
Combinations of two or even three medications may be more effective than a single medication. Often, a lot of time is spent in trying different medications and combinations of medications to find the most effective medical treatment. Side effects, such as feeling tired, can limit the use of some of the medications.
Your doctor might suggest you try a nerve block, which is an injection with an anesthetic that will stop the nerve from hurting, at least for a little while.
If medicines do not help enough and the pain is affecting your ability to function, you may need surgery. During surgery, your doctor will damage or destroy certain nerves using chemicals, electric currents, radiation or other means. The trigeminal nerve itself might be cut to eliminate or reduce the pain.
Any surgery in which nerves are destroyed will cause some ongoing numbness. Some patients would prefer the feeling of numbness over the intense pain. Whatever the option, work with your doctor to decide on what’s best of you. Suicide should not be part of that option.

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