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Trigeminal Neuralgia

Trigeminal Neuralgia is an extremely painful condition usually involving one side of the face. It usually occurs spontaneously, but is sometimes associated with trauma or dental procedures. It has a characteristic feeling of “shock-like” pain which travels through the face in a matter of seconds, but can occur in a repetitive fashion. Depending on where it occurs, there are common triggers that seem to cause the pain or worsen it. These are:

  • Three physicians discussing pain managementTouching the face
  • Brushing the teeth
  • Eating, drinking, chewing or talking
  • Shaving
  • Water hitting the face when taking a shower
  • Touching a tooth or the lip with the tongue
  • Feeling a slight wind or breeze on the face
  • Sometimes, nothing at all

Intensity of pain
The intensity of the pain is exceptional, and it is felt to be more severe than experiencing a heart attack, passing a kidney stone, or even having a baby. Unfortunately, since most observers have not experienced such discomfort, they often liken it to a toothache or a headache – but it is in a league by itself.

Who gets it and why?
Trigeminal neuralgia seems to occur much more often in women than men. It seems to be more common in older patients (usually over 60 years), and it occurs more on the right than the left. It is not usually a familial trait. It can be very active for a time, and then seem to disappear, sometimes for long periods, but always recurs later, often with more intensity. This does not mean than young male patients with left-sided pain whose mother had the same condition cannot have trigeminal neuralgia – or that it cannot occur on both sides. These are just the most common presenting characteristics.

We also know that the most commonly accepted theory of what causes trigeminal neuralgia is vascular compression. There are blood vessels that travel with the nerve, and if they cause pressure on the nerve or irritate it, pain can occur. In addition, some demyelinating conditions, such as multiple sclerosis, can have adverse effects on nerves, including the trigeminal nerve and cause neuralgia. There is controversy over post-herpetic neuralgia (caused by shingles) and whether it can be related to this condition.

Diagnosis
Your doctor will ask for a complete medical history and will perform a thorough physical examination. Diagnostic tests may include:

1. MRI scan
2. EMG test.  This test studies electrical activity in the nerves of the face.

However, there is no one test to diagnose this condition.  The only way to diagnose this disorder is by taking a careful history to determine the quality and quantity of the pain, its triggers, and what makes it feel better or worse. In other words, you need to be very detailed in your description, and your clinician needs to listen carefully.

Treatment
Research is the forefront of our mission at the Johns Hopkins Facial Paralysis and Nerve Treatment Center.  Dr. Benjamin Carson has found success in treating patients with trigeminal neuralgia using glycerin injections and is at the forefront of doing research on this debilitating condition.  Further treatments may include medication, gamma knife therapy, microvascular decompression, and several kinds of specialized injections.

 

 

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