Why does your face hurt?
One morning as you’re brushing your teeth before work, you experience a sudden, sharp, stabbing pain. It goes away quickly, so you figure it was some sort of fluke. A week later, you’re washing your face before going to bed, and the same thing happens again. What’s wrong with your face? Is there a treatment for it? Can you prevent the pain from coming back?
The trigeminal nerve provides sensation from your face to your brain. Trigeminal neuralgia, or tic douloureux, is when the nerve isn’t working correctly. Typically, it’s caused by pressure being placed on the trigeminal nerve from a blood vessel (artery or vein). It can also be the result of aging or related to conditions/injuries that damage the nerves. It’s more likely to appear in those over 50 and affects women more than men.
People with the condition will have excruciating pain from even mild stimulation. Initially, the attacks are mild and short, but they can progress into longer, more frequent occurrences. Triggers can include shaving, eating, drinking, touching your face, brushing your teeth, talking, putting on makeup, smiling, washing your face, and encountering a breeze. Symptoms are episodes of severe/shooting/jabbing pain that may feel like an electric shock; spontaneous attacks of pain; bouts of pain lasting from a few seconds to several minutes; episodes of several attacks lasting days, weeks, months, or longer (some people have periods when they have no pain); constant aching/burning feeling that happens before it evolves into the spasm-like pain; pain in areas supplied by the trigeminal nerve (ex. cheek, jaw, teeth, gums, lips, or less often the eye and forehead); pain affecting one side of the face at a time (rarely affects both sides of the face); pain focused in one spot or spread in a broader pattern; and attacks that become more frequent and intense over time.
There are many treatment options for trigeminal neuralgia. The first step is usually medication to lessen or block the pain signals sent to your brain. Anticonvulsants are generally the primary type of medicine used. Examples of this are carbamazepine, oxcarbazepine, lamotrigine, phenytoin, clonazepam, and gabapentin. Sometimes, antispasmodic agents, such as baclofen, are used alone or in combination with carbamazepine.
Over time, some individuals stop responding to medicines, so your doctor may suggest Botox injections or surgery to relieve the pain. There are several different options for surgery. Microvascular decompression is when the offending blood vessels are relocated or removed. Brain stereotactic radiosurgery involves directing a dose of radiation to the root of the trigeminal nerve. With a rhizotomy, the nerve fibers are destroyed with one of three options. Glycerol injections is the drug is injected into the small sac of fluid surrounding the trigeminal nerve root. Balloon compression is when the trigeminal nerve is damaged by the surgeon purposefully inserting a catheter into the area where the nerve goes through the base of your skull and inflating a balloon. For radiofrequency thermal lesioning, the trigeminal nerve is destroyed by passing a small electric current through the tip of an electrode place in the same place as balloon compression.
There isn’t a way to prevent trigeminal neuralgia from occurring. The goal should be to reduce the frequency of attacks by being aware of your triggers and avoiding them. Since the condition can impact your life in many ways, seeking support from a group or counseling can help prevent emotional side effects.
Trigeminal neuralgia is incredibly painful. However, there are treatments available to help you live as pain-free as possible. If you have any questions or concerns about trigeminal neuralgia, please speak with your doctor. If you would like more information, please visit the American Association of Neurological Surgeons’ trigeminal neuralgia page at https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Trigeminal-Neuralgia