 Facial Pain
Frequently
Asked Questions
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Facial Pain
(by
MHNI Staff)
What is trigeminal neuralgia?
Scenario:
James is a 65-year-old man who awoke one day with
severe pain in his face. The pain
seemed to tear through his face like a lightening bolt. It was brief but excruciating
pain which came in
repeated flashes when activated. James could not shave over the
right side of his face, chew tough foods or talk for any length of time without
triggering pain. He could not even tolerate a light breeze blowing across his face.
James suffers from trigeminal neuralgia which is one of many different neuralgias.
A neuralgia is a type of pain which is thought to be caused by nerve injury
or irritation.
Trigeminal neuralgia, also known as tic douloureux, is a painful condition
which affects the face. The trigeminal nerve provides all sensation, including pain,
to the face, teeth, mouth, sinuses, meninges (coverings of the brain) and blood
vessels of the head. There are two trigeminal nerves, one on each side of the head,
and each has three branches supplying the upper, middle and lower parts of the face.
The pain of trigeminal neuralgia is felt in the territory of one or more branches
of this nerve. It usually occurs on one side of the face; in rare cases it can affect
both sides at the same time.
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What does the pain feel like?
The pain is severe, brief, sharp,
jolting and shock-like. A longer lasting deep, burning or dull pain may persist in between the lightening-like jolts. People with trigeminal neuralgia have numerous
attacks each day, sometimes hundreds. The duration of each painful jab is very brief,
lasting only seconds. The pain may be triggered by chewing, talking, shaving, brushing
teeth, light touch, cold air or wind blowing upon the face.
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Who is the typical trigeminal neuralgia sufferer?
Trigeminal neuralgia usually occurs in people over 60 years old but may occur at
any age. When trigeminal neuralgia occurs in a young person, multiple sclerosis
or other diseases of the nerves can be possible causes. Trigeminal neuralgia can
occur after an injury or compression of the nerve or can be the result of dental
abnormalities. Some cases of trigeminal neuralgia have no identifiable cause.
Neuralgia pain is very intense and excruciating. People who have neuralgia are often
depressed and frustrated. The pain affects every aspect of their lives because it
occurs very frequently and rapidly without warning. People suffering with trigeminal
neuralgia often find the pain to be so intense that they cannot even think clearly
and may begin to believe that suicide is the only
way to find relief.
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What about treatments?
Fortunately, there are many different kinds of medical, anesthesiologic and surgical
treatments available for the control of trigeminal neuralgia. Medications often
used to control the pain of trigeminal neuralgia include carbamazepine, phenytoin,
baclofen, divalproex sodium, gabapentin and clonazepam. Different kinds of anesthesiologic
treatments are available including trigeminal nerve blocks, radiofrequency neurolysis
(heating the nerve with a focused microwave), cryoneurolysis (freezing the nerve)
and radiosurgery (radiation treatments). Surgery to expose the trigeminal nerve
and remove blood vessels which may be pressing on the nerve is sometimes necessary.
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