March 7, 2024 | Imagine you are brushing your teeth or putting on makeup when you suddenly feel a sudden sharp pain similar to an electric shock on one side of your face. People with trigeminal neuralgia, a chronic condition, may at first experience short, mild episodes of pain. But the condition can get worse, causing longer periods of pain that happen more often. It’s more common in women and people older than 50 but it can occur at any age. When trigeminal neuralgia, or TN, affects people younger than 40, it can be due to multiple sclerosis or a tumor. The pain of TN comes from the trigeminal nerve. This nerve carries the sensations of touch and pain from the face, eyes, sinuses, and mouth to the brain. Because pain can occur in the upper or lower jaw, people may go to the dentist thinking that they have a dental issue. Although the pain from trigeminal neuralgia is not life threatening, it is very severe and can be both physically and mentally disabling.

March 7, 2024 | Trigeminal neuralgia causes episodes of sudden extreme electric shock-like, shooting, stabbing or sharp pain in the face. There are two types of TN. In Type 1 TN, the pain is typically felt on one side of the face, usually the right. These intermittent intense flashes of pain can be triggered by a light touch, such as when washing the face or shaving, drinking or being exposed to cold air. In general, the pain lasts from less than a second up to several minutes. Sometimes, people have multiple episodes of pain that can last up to one hour. People with Type 2 TN have constant aching, burning, and stabbing pain with or without the intermittent shocking of Type 1 TN. While some trigeminal neuralgia sufferers have continuous pain, most people experience a pattern of pain that worsens and then stops for some time. Pain-free periods can last months or years. However, TN attacks often worsen over time, with fewer pain-free periods before they recur.

March 7, 2024 | Though it is rare, trigeminal neuralgia is considered one of the most painful conditions to affect people. Dr. Erika Petersen, a professor in the Department of Neurosurgery at UAMS, says trigeminal neuralgia, or TN, may be caused by a blood vessel pressing on the trigeminal nerve. The blood vessel may be an artery or a vein. This pressure causes the protective coating around the nerve, the myelin sheath, to wear away or become damaged. As a result, the nerve does not work as it should. Dr. Petersen says that while compression by a blood vessel can be a common cause for TN, there are many other potential causes. Multiple sclerosis or a similar condition that damages the myelin sheath protecting certain nerves can cause TN. A tumor pressing against the trigeminal nerve also can cause the condition. Some people may experience trigeminal neuralgia as a result of a stroke or facial trauma. An injury of the nerve due to surgery also can cause TN.

March 7, 2024 | Certain medical tests are necessary to accurately diagnose trigeminal neuralgia and what’s causing it. A neurologist with experience in treating TN will discuss the type of pain you suffer from, its location on your face and what kind of things trigger the pain. A neurological exam will involve touching and examining parts of your face to help determine exactly where the pain is occurring. If you appear to have TN, the exam can help uncover which branches of the trigeminal nerve may be affected. Reflex tests can help determine if your symptoms are caused by a compressed nerve or another condition. An MRI may also be ordered to reveal signs of multiple sclerosis or a tumor. Sometimes a dye is injected into a blood vessel to view the arteries and veins to show blood flow. Because facial pain can be caused by many different conditions, an accurate diagnosis is important. Your neurologist also may order other diagnostic tests to rule out other medical conditions.

March 7, 2024 | Treating trigeminal neuralgia usually starts with medications to lessen or block the pain signals sent to your brain. Anticonvulsant medicines can reduce the frequency of attacks. If a single drug fails to improve symptoms, more than one drug may be used at the same time. Other medications may be tried, particularly if anticonvulsants are not effective or side effects are too bothersome. If medication fails to relieve pain or produces intolerable side effects such as cognitive disturbances, memory loss, excess fatigue or bone marrow suppression, the doctor may recommend surgery. Since TN can be a progressive disorder that becomes resistant to medication over time, surgery is a common approach to reducing the risk of future attacks of pain. Some surgeries to address TN are done on an outpatient basis, while others may involve a more complex operation that is performed under general anesthesia and requires a hospital stay.