What is Trigeminal Neuralgia?

Diagnosis and Management of this Common Cause of Facial Pain

Jul 21, 2008 John Richard Roberts

Trigeminal neuralgia is the most common cause of facial pain. Normally one-sided, it manifests as spasms of severe lancing pain in the side of the face.

It occurs mostly in those over the age of 60 years and is more common in women. Attacks can happen every few minutes or every few days. Between bouts there is often a dull ache in the area affected. Although the pain is not constant, attacks are so severe as to have a marked effect on family and social life. Fortunately, however, remissions of months or years can occur.

In most sufferers there will be an area on the face which, when touched, will trigger a spasm of pain. This can obviously make washing and shaving difficult. Eating can also set off the pain. All in all it’s pretty miserable.

The Trigeminal Nerve

There are two trigeminal nerves, one for each side of the face. They arise in the brain stem just below the main body of the brain. Each nerve branches into three: one part supplying the eye and forehead, the second part serves the upper part of the cheek and the third supplies the jaw and lower cheek.

The trigeminal nerve is responsible for the sense of touch in those parts of the face it serves and controls the muscular movement in the jaw: chewing and speaking. Trigeminal neuralgia involves pain only, it does not affect the power of the jaw muscles so any difficulty in eating or speaking is due to the severity of the pain. The condition mostly affects the second or third part of the nerve.

Causes of Trigeminal Neuralgia

• Idiopathic: this means that the cause is unknown and this is the case with most occurrences of the condition. There is a suggestion that it may be due to compression of the roots of the nerve.
• Multiple sclerosis: not a common cause and more likely in younger people with this condition when it sometimes occurs on both sides of the face.
• Tumours: those in the region of the brain stem may impinge on the nerve and produce the neuralgia.

Management of Trigeminal Neuralgia

• Drugs: carbamazepine is the usual treatment. Many patients respond to this although sometimes the effect of the drug wears off after a number of years. Another problem is that some patients are considerably affected by the side-effects of the drug – such as nausea, vomiting and drowsiness.
• Surgery: the usual next step for those who are resistant to drugs or have too many side-effects. A common method is to destroy part of the nerve by radiofrequency generated heat. The response to this is generally very good. Adverse effects such as permanent numbness or paralysis of part of the face are rare.
• Acupuncture: although there is no hard evidence for the effectiveness of acupuncture in trigeminal neuralgia (mainly because little high quality research has been carried out) some patients have reported finding some relief.

This article is for information only. If you have any health concerns you should consult your doctor.

ResourceMedicine Eds. Souhami and Moxham Pub. Churchill Livingstone 2003

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