Trigeminal neuralgia

Trigeminal neuralgia happens when the trigeminal nerve that carries sensation from your forehead, cheeks, jaw and the area around your eyes is compressed. This causes sudden, severe face pain. It usually happens because a blood vessel is pressing on this nerve, though tumors and infections can also cause trigeminal neuralgia.

Trigeminal neuralgia symptoms

The primary symptom of trigeminal neuralgia is sudden, severe and sharp facial pain. This pain is typically experienced on one side of your face and can be triggered by things such as:

• Touching your face
• Chewing
• Speaking
• Brushing your teeth
• Exposure to cold air or wind
• Drinking hot or cold beverages
• Smiling or facial expressions

The pain is often described as electric shock-like or stabbing and can last from a few seconds to several minutes. Between episodes of pain, you may experience periods of remission where you are pain-free.

In addition to the characteristic facial pain, you may experience other trigeminal symptoms, including:

• Tingling or numbness in your face before the onset of pain
• Muscle spasms in your face
• A constant aching or burning sensation in the affected area

It's important to note that the symptoms of trigeminal neuralgia can vary from person to person, and the severity and frequency of pain episodes can also differ. If you suspect you have trigeminal neuralgia, it's essential to talk with your doctor for an accurate diagnosis and treatment plan.

What happens if trigeminal neuralgia goes untreated?

If trigeminal neuralgia goes untreated, the symptoms can worsen over time and significantly impact your quality of life.

Without treatment, the episodes of intense facial pain may become more frequent, longer lasting and more severe. This can lead to constant or near-constant pain, making it challenging to perform daily activities and affecting your overall well-being.

Chronic pain conditions like trigeminal neuralgia can sometimes lead to secondary complications, such as weight loss due to difficulty eating, sleep disturbances and medication side effects.

How do I know if my trigeminal nerve is damaged?

Damage to the trigeminal nerve can result in various symptoms, depending on the extent and location of the damage. Signs and symptoms that may indicate trigeminal nerve damage include:

• Facial tingling, pain or numbness
• Muscle weakness
• Sensory loss
• Altered reflexes
• Face asymmetry

Diagnosing trigeminal neuralgia

If you feel you may have trigeminal neuralgia, your first visit typically involves a physical exam, including a review of your medical history and symptoms. Your provider may refer you to a neurologist or pain specialist for further evaluation and diagnosis.

While there’s no specific test to diagnose trigeminal neuralgia, imaging tests such as an MRI or CT scan may be ordered to rule out other underlying causes of facial pain, such as tumors.

There are times additional diagnostic tests may be recommended to confirm your diagnosis or assess the function of your trigeminal nerve. These may include:

• Neurological tests: Includes a series of assessments of your sensory function, reflexes and muscle strength to evaluate your trigeminal nerve.
• Nerve conduction studies: These tests measure the electrical activity of the trigeminal nerve and can help identify abnormalities in nerve function.
• Electromyography (EMG): EMG may be used to evaluate muscle activity and detect abnormalities in facial muscles associated with trigeminal neuralgia.

Your provider may consider other potential causes of facial pain, such as dental problems, sinusitis, TMJ disorders or other neurological conditions.

Treatment options for trigeminal neuralgia

The choice of treatment depends on various factors, including the severity of your symptoms and the underlying cause of your trigeminal neuralgia. The goal of your personalized treatment plans is to alleviate your pain and reduce the frequency of your trigeminal neuralgia episodes.

Trigeminal neuralgia treatment may include:

• Medication: Medications commonly used to treat seizures can help reduce nerve pain associated with trigeminal neuralgia. You may also be prescribed muscle relaxants or antidepressants.
• Nerve blocks: Injecting a local anesthetic, such as lidocaine, directly into the area around the trigeminal nerve can provide temporary pain relief.
• Microvascular decompression: A common, minimally invasive surgery used to stop the blood vessel from pressing on the nerve.
• Stereotactic radiosurgery: Using CyberKnife®, a non-invasive, robotic system delivers high radiation doses to the nerves with pinpoint accuracy.
• Acupuncture: Some people find relief from trigeminal neuralgia symptoms through acupuncture, although the evidence for its effectiveness is mixed.

With your treatment, it's essential to work closely with your doctor with regular follow-up visits. This allows adjustments to your treatment plan if needed to ensure optimal pain management and overall well-being.