What Is Trigeminal Neuralgia?
Trigeminal neuralgia is chronic pain in a distribution of the trigeminal nerve, which is responsible for sensation and muscle movement in the face. People with trigeminal neuralgia feel stabbing pain, whether it’s the motion involved in speaking or a breeze on the face. Episodes are often mild and infrequent at first but then progress to regular, longer-lasting and extremely painful attacks. Sometimes the symptoms will subside altogether for a period but then resume.
Women are more prone to trigeminal neuralgia, which can have a number of causes, including:
- Aging — The condition is seen more often in people over age 50.
- Diseases that affect the nerve covering, such as multiple sclerosis
- A tumor pressing on the trigeminal nerve
- A brain lesion or other abnormality
- Facial trauma
Common triggers of trigeminal neuralgia pain are:
- Grooming that involves the face, such as shaving, washing the face, putting on makeup or brushing teeth
- Facial motions, such as smiling, eating, drinking or talking
- Anything touching the face
The pain from trigeminal neuralgia can vary in type, intensity and duration. Episodes can last from a few seconds to several minutes, and recur for weeks, months or longer. Symptoms might include:
- Episodes of severe pain — Patients may describe it as shooting or stabbing, or like an electric shock.
- Aching or burning pain — Continuous aching or burning may precede an episode of stabbing pain.
- Spreading pain — This pain begins in one spot and then spreads.
- Pain that runs down one side of the face — Typically the pain is felt in the cheek, jaw, teeth, gums and lips. Occasionally it is felt in the eye and forehead. On rare occasions the pain is on both sides of the face.
Prescription medications, such as antispasmodics and anticonvulsants, ease the symptoms of trigeminal neuralgia, although they can have side effects, such as nausea, confusion and dizziness. If the side effects are intolerable, or if the pain becomes chronic or unmanageable, a physician can offer several other treatment options, including:
- Microvascular decompression — This surgery eliminates or reduces the pain by removing or relocating any blood vessels touching the trigeminal nerve.
- Brain stereotactic radiosurgery — Also known as Gamma Knife® surgery, this procedure involves the surgeon using focused radiation to damage the trigeminal nerve, with pain typically subsiding within a month. The procedure can be repeated if necessary.
- Rhizotomy — During this procedure, performed under sedation, the surgeon inserts a hollow needle through the face to damage the trigeminal nerve and block pain signals. A rhizotomy can cause some facial numbness, and pain relief may not be permanent.
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