Trigeminal Neuralgia Symptoms & Triggers

Trigeminal Neuralgia Symptoms & Causes: Understanding Facial Nerve Pain

Trigeminal neuralgia is a condition that leads to sudden, intense facial pain. This happens when something, often a blood vessel, presses on the trigeminal nerve near the brain. Since this nerve controls facial sensation, even simple actions like eating, talking, smiling, or brushing your teeth can trigger sharp, stabbing pain.

While trigeminal neuralgia isn’t life-threatening, it can seriously affect your daily life and emotional health. It’s usually a long-lasting (chronic) condition, but there are treatments available that can help manage the pain and improve quality of life.

In this guide, we’ll explain what trigeminal neuralgia is, the symptoms of trigeminal neuralgia, how it can be treated, and tips to manage the pain.

Keep reading for detailed insight!

What are the Symptoms of Trigeminal Neuralgia?

People with trigeminal neuralgia may experience one or more of the following signs:

• Sudden, stabbing, or shock-like facial pain.
• Pain that is triggered by touching the face, chewing, talking, or brushing teeth.
• Pain that lasts for a few seconds to a few minutes.
• Facial twitches or spasms during pain episodes.
• Pain that can last for days, weeks, or even longer, with pain-free periods in between.
• Pain in areas like the cheek, jaw, teeth, gums, lips, and sometimes the eye or forehead.
• Pain that usually affects only one side of the face.
• Pain that is felt in a small spot or spread over a larger area.
• Pain that rarely happens during sleep.
• Pain episodes become more frequent and stronger over time.

What are the Causes of Trigeminal Neuralgia?

Trigeminal neuralgia arises when the trigeminal nerve, responsible for facial sensation, becomes affected. The most frequent cause is compression by a nearby blood vessel close to where the nerve connects to the brain. This compression interferes with the nerve's normal function, leading to episodes of intense facial pain.

Other possible causes include:

• Multiple sclerosis damages the protective covering (myelin sheath) of nerves.
• Tumours that press on the trigeminal nerve.
• Stroke can affect nerve pathways.
• Facial injuries or nerve damage from surgery.

What are the Common Triggers for Trigeminal Neuralgia?

Certain everyday activities can trigger pain in people with trigeminal neuralgia. These include:

• Shaving
• Touching the face
• Eating or drinking
• Brushing your teeth
• Talking or smiling
• Applying makeup
• Washing your face
• Feeling a breeze or wind on your face

What are the Risk Factors for Trigeminal Neuralgia?

Some people are more likely to develop trigeminal neuralgia due to certain risk factors:

• Gender: Women are more often affected than men
• Age: The condition is more common in people over the age of 50
• Other Health Problems: People with high blood pressure or multiple sclerosis have a higher risk of developing trigeminal neuralgia

How is Trigeminal Neuralgia Diagnosed?

To find out if you have trigeminal neuralgia, your doctor will likely do a few tests. These help confirm the condition and find out what might be causing it. They include:

• Neurological Exam: Your doctor may gently touch or press parts of your face to see where the pain is. This helps figure out which part of the trigeminal nerve is affected. Reflex checks can also show if the pain is coming from nerve pressure or another issue.
• MRI Scan: A magnetic resonance imaging (MRI) scan may be done to check for other problems, like multiple sclerosis or a tumour. Sometimes, a special dye is used during the scan to help show blood flow and spot blood vessels pressing on the nerve.

What are the Treatments for Trigeminal Neuralgia?

Most people with trigeminal neuralgia start with medicines to manage the pain. Some feel better with just medication, but others may need additional treatments like injections or surgery if the medicine stops working or causes side effects.

Here is a detailed overview:

1. Medications

Doctors often use medicines that reduce or block the pain signals going to your brain. These include:

• Anti-seizure Drugs: These are the most common treatments. Medicines like carbamazepine (Tegretol) are often used first and can help control the pain. Others include oxcarbazepine, lamotrigine, phenytoin, topiramate, pregabalin, and gabapentin.
• Muscle Relaxants: Baclofen is sometimes used alone or along with anti-seizure drugs. It may cause drowsiness, nausea, or confusion.
• Botox Injections: Botulinum toxin (Botox) injections are an established treatment option for drug-resistant trigeminal neuralgia. Clinical guidelines support its use when anti-seizure medications are ineffective or not tolerated.

2. Surgical Treatments for Trigeminal Neuralgia

If medications no longer help with trigeminal neuralgia or cause unwanted side effects, surgery may be another option. Here's a breakdown in simple terms:

Microvascular Decompression (MVD)

This surgery involves moving or removing blood vessels that press on the trigeminal nerve. Here's how it works:

• A cut is made behind your ear on the side where you feel pain.
• A small opening is made in your skull to reach the nerve.
• The surgeon moves any blood vessels pressing on the nerve and places a soft cushion between them.
• If a vein is causing the problem, it may be removed. In some cases, part of the nerve may be cut (called a neurectomy).

Stereotactic Radiosurgery (Gamma Knife)

This is a non-invasive option that uses focused radiation to target the root of the trigeminal nerve.

• A high dose of radiation is aimed at the nerve without making any cuts.
• This damages the nerve just enough to reduce or stop pain.

Rhizotomy Procedures

These are methods that intentionally damage the trigeminal nerve to stop pain signals. They usually cause some facial numbness. There are several types:

• Glycerol Injection: A needle is inserted through the face to the base of the skull. A small amount of glycerol is injected to damage the nerve and stop pain signals.
• Many people feel quick pain relief, but the pain might return later. Numbness or tingling in the face is common afterwards.
• Balloon Compression: A needle and a small balloon are guided to the nerve. The balloon is inflated briefly to press on and damage the nerve. This usually gives pain relief for a while. Temporary facial numbness is common.
• Radiofrequency Thermal Lesioning: A needle is inserted to reach the trigeminal nerve, and a small electrical current is used to locate the pain area. Then, heat is applied to damage the nerve and stop pain signals. This often provides relief, but pain may come back after 3–4 years. Temporary numbness is expected.

Understanding trigeminal neuralgia symptoms can help you seek timely medical care and manage the condition more effectively. With the right diagnosis and treatment plan, many people find relief from the pain and return to a better quality of life.

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