Trigeminal neuralgia

The trigeminal nerve transmits sensation from parts of the face to the brain and controls some of the muscles that are involved in chewing. Damage to this nerve causes repeated bursts of sharp, stabbing pain, known as trigeminal neuralgia, in the lip, gum, or cheek on one side of the face. Attacks may last for a few seconds or several minutes and may become more frequent over time. In severe cases, the pain may be so intense that the affected person is unable to do anything during the attack. Afterwards, the pain usually disappears completely. An attack may occur spontaneously or be triggered by certain facial movements, such as chewing, or by touching a trigger spot on the face. Attacks rarely occur at night.

Trigeminal neuralgia affects about 1 in 25,000 people in the UK. The disorder is most common in men over the age of 50. The cause of trigeminal neuralgia is usually unknown. However, in people under 50, symptoms may be an early sign of multiple sclerosis. Rarely, the nerve is compressed by a tumour or by a dilated blood vessel.


What may be done?

There are no specific tests to diagnose trigeminal neuralgia. Your doctor will examine you to rule out any other causes of facial pain, such as toothache or sinusitis. He or she may also arrange for you to have MRI to look for the presence of a tumour.

Your doctor may prescribe painkillers, such as paracetamol or ibuprofen. However, if the pain persists, your doctor may prescribe anticonvulsant drugs, such as carbamazapine, or certain antidepressants, all of which have been shown to be effective in treating trigeminal neuralgia. Unlike painkillers, which are taken only when the pain is present, both anticonvulsants and antidepressants need to be taken every day to prevent attacks.

If a tumour is found, surgery may be necessary to remove it. Surgery may also be used to separate the trigeminal nerve from a blood vessel if the vessel is compressing the nerve. Rarely, people who have persistent, severe pain that does not respond to drugs are offered treatment to numb the affected side of the face. For example, pain can be alleviated by using a heated probe to destroy the nerve. Alternatively, the trigeminal nerve may be cut, or alcohol may be injected into the nerve to deaden it. Trigeminal neuralgia will not recur after treatment to numb the face, but you will need to take care when consuming hot food or drinks because of the lack of sensation in your face.

Attacks of neuralgia may stop spontaneously, become more frequent, or persist unchanged for months or years. However, symptoms usually improve significantly with treatment.