Trigeminal neuralgia refers to sudden and sharp facial pain. The Department of Anaesthesiology at Singapore General Hospital gives a detailed overview of this condition.
Do you sometimes experience sudden sharp or shooting pain on one side of your face? It could be a nerve disorder called trigeminal neuralgia. Beginning with mild twinges of facial pain, it may lead to longer episodes of pain lasting several hours and days.
“If trigeminal neuralgia is left untreated, even basic activities such as shaving, washing your face and brushing your teeth could trigger excruciating facial pain,” says
Dr Tan Kian Hian, Senior Consultant,
Department of Anaesthesiology and Director,
Pain Management Centre,
Singapore General Hospital (SGH), a member of the
SingHealth group.
Trigeminal neuralgia tends to affect older people in their 60s and 70s, particularly women over the age of 50.
What is trigeminal neuralgia?
Trigeminal neuralgia may be caused by an artery or blood vessel pressing on the trigeminal nerve – the largest cranial nerve located at the base of the brain. The trigeminal nerve controls sensations in the face and the muscles used in chewing, eating and talking.
What causes trigeminal neuralgia?
The exact cause remains unknown. However, certain conditions such as multiple sclerosis or a tumour pressing on the trigeminal nerve can trigger the electric shock-like pain associated with trigeminal neuralgia.
Symptoms of trigeminal neuralgia
Facial pain caused by trigeminal neuralgia may take different forms:
- Occasional mild pain in areas controlled by the trigeminal nerve - the cheeks, teeth, gums, lips and jaws
- Spontaneous outbursts of pain triggered by mild facial stimulations such as chewing or shaving or a simple touch
- Bouts of radiating facial pain lasting a few seconds to several minutes
- Longer episodes of pain attacks lasting days, weeks or even months
How is trigeminal neuralgia diagnosed?
A neurological examination will be conducted to identify areas of facial pain. Talk to your doctor about the severity, duration, frequency and location of the facial pain.
A MRI scan may be necessary to diagnose multiple sclerosis and other medical causes.
Treatment for trigeminal neuralgia
Patients may feel that their lives have spun out of control because of the debilitating facial pain, but trigeminal neuralgia is not life-threatening. There are non-surgical and surgical treatment options available to help patients manage the pain, says Dr Tan.
Pain relief medications
Over-the-counter pain relief medications such as ibuprofen and paracetamol may be ineffective in treating trigeminal neuralgia.
Doctors may prescribe anticonvulsant medications such as carbamazepine (Tegretol) to reduce facial pain and block pain signals from reaching the brain.
If, despite increased dosage, the anticonvulsant medications fail to provide any pain relief, doctors may recommend radio frequency lesioning (to destroy nerve fibres using electric current) or neurosurgery.
Neurosurgical options to relieve facial pain
The purpose of these neurosurgical procedures is to remove the compressing blood vessel or create mild damage to the trigeminal nerve so that it can no longer send pain signals to the brain.
Associate Professor Ng Wai Hoe, Senior Consultant and Head, Department of Neurosurgery, National Neuroscience Institute (NNI), a member of the SingHealth group, describes the three main neurosurgical procedures for trigeminal neuralgia.
Microvascular decompression
This surgery eliminates facial pain by separating or diverting the blood vessel compressing the trigeminal root. Because the incision is made behind the ear on the side of the pain, there is a small risk of decreased hearing and facial weakness.
Radiosurgery
This painless procedure uses focused radiation to create mild damage to the root of the trigeminal nerve, which can eliminate facial pain altogether.
Partial sensory rhizotomy
This procedure involves cutting part of the trigeminal nerve, but it will result in permanent facial numbness.
Caring for family members with trigeminal neuralgia can be challenging. Patients cannot eat, smile, talk or laugh normally due to facial pain. Be patient, supportive and watch out for any signs of depression, adds Dr Tan.
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