Trigeminal Neuralgia – The Facial Pain

Spina Bifida

The pain caused by the irritation of the trigeminal nerve is perhaps the worst kind of pain that can be experienced by a human. It typically affects the lower face and jaw and presents as an intense bout of stabbing, electric-shock like pain; in some cases, the pain may also affect the nose and forehead area. This chronic pain disorder is known as trigeminal neuralgia and may occur even after mild stimulations like brushing the teeth, speaking, washing the face or applying make-up. The debilitating pain starts off as short mild attacks, progressing to longer and more frequent bouts of excruciating pain. It is more common after the age of 50 and affects more women than men.

It manifests as two forms; the typical form includes intense, sudden shock-like pain that can last for a few seconds to minutes and affects one side of the face only. The atypical form presents as a constant searing pain that is continuous and less intense. Living with the severe pain experienced on the slightest stimulation of the nerve can lead to depression in people, but one shouldn’t feel doomed to a life of pain as there are various ways that a neurologist can help you control it.
The trigeminal nerve is the fifth pair of cranial nerves that provides sensation to the forehead, cheek and lower jaw. The pain is usually limited to one side of the face as only one of the pair of nerves may be irritated. It’s generally believed that loss of the myelin sheath surrounding the nerve due to compression, trauma, tumor, aging, stroke or multiple sclerosis may be the trigger for trigeminal neuralgia.

Diagnosis of the condition is usually based on the description of the pain and its location by the patient as well as an associated neurological examination. The neurologist may request an MRI scan to rule out underlying disease conditions as well as to determine the cause of irritation of the nerve. Depending on the patient’s history, some other tests might also be needed.

Though the condition can’t always be cured, there are medications available to control the pain. Anticonvulsant drugs are the first line of treatment followed by antispasmodic agents that relax the muscles. Botox injections have also been used in some cases, although its usefulness in trigeminal neuralgia is still under research.

And when nothing else works, there is always the surgical intervention available as a last option. Non-destructive surgical options include microvascular decompression where a teflon pad is placed in between the nerve and the blood vessel compressing the nerve. This procedure, known as microvascular decompression, is highly effective in cases where the MRI demonstrates a neurovascular conflict. In destructive surgery, the nerve is destroyed providing pain relief; however it comes with associated facial numbness. Nerve destruction can be done through balloon compression, glycerol injection, and stereotactic radiosurgery or through a percutaneous technique to damage the nerve. Destructive techniques (except stereotactic radiosurgery) have largely fallen out of favour due to their adverse effects and high recurrence rates.

The patient shouldn’t feel isolated in their pain as so many options are available with the neurologist for its treatment.

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