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Johns Hopkins Health - Facing Pain

Winter 2013
Issue No. 19

Facing Pain

Date: January 17, 2013

Facing Pain

Intermittent yet excruciating pain in your face could be a sign of a nerve disorder. Michael Lim, M.D., a neurosurgeon at Johns Hopkins, explains the condition and the treatments that can bring relief

How can I find relief?
The first line of treatment is usually medication. A majority of people respond well and their pain is well-controlled. If medication doesn’t work, there are three surgical options. Be sure to seek out a treatment center, like the Johns Hopkins Trigeminal Neuralgia Center, that has extensive experience and handles a high volume of cases.

Recently I started experiencing sharp facial pain. What is going on?
There are many causes of facial pain. One of them, trigeminal neuralgia, is characterized by episodic stabbing pain over the forehead and eyes or near the cheek, nose or jaw. Some people describe a sensation of electric shocks or ice picks. The pain, usually on one side of the face, can be triggered by eating, drinking, talking or feeling a slight wind or breeze.

Can you tell me about the surgical treatments?
The first is called microvascular decompression. It’s an open surgery involving a small incision to lift the artery off the troublesome nerve and insert a cushion to eliminate rubbing. Although a short hospital stay is required, about 90 percent of people are completely cured. The second is called a rhizotomy, where a needle is used to insert medicine or apply other treatments to stop the pain. It’s an outpatient procedure, but the pain typically returns within a few years. For the third option, doctors deliver focused beams of radiation to the nerve. People return to work the same day, but the procedure doesn’t take effect right away and the pain can return a few years later.

What causes trigeminal neuralgia?
No one is exactly sure, but many people believe the cause is an artery that rubs on the nerve near the brainstem. As people age, the insulation on the nerve wears down, much like wires in a home that cause electrical shocks when exposed.

Do You Experience Facial Pain?

Watch a video of Michael Lim, M.D., Johns Hopkins neurosurgeon, to learn more about the symptoms, causes and treatment options for trigeminal neuralgia, visit For more information, appointments or consultations, call 877-546-1872.

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