Understanding Trigeminal Neuralgia

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Researchers think that a blood vessel pressing against the trigeminal nerve triggers the pain. Other possible causes may be:

• Multiple sclerosis (MS)
• A tumor pressing on the nerve
• An abnormal tangle of arteries and veins
• Nerve damage from oral surgery, stroke, or injury to the face

It happens most often in people older than 50. But younger people can also have it. Trigeminal neuralgia is more common in females.

The pain can be triggered by pressure on your cheek. This pressure may come from a razor when shaving. Or from your fingers when putting on makeup. Brushing your teeth, standing in the wind, washing your face, eating, drinking, and even talking may trigger attacks of pain.

A flare-up begins with tingling or numbness in the area. Then pain starts to come and go, often in bursts that last anywhere from a few seconds to 2 minutes. During a flare-up, these bursts of pain may occur more often until the pain almost never stops. The pain can be so severe it can make it hard to get through your day. But it’s not life-threatening.

People with trigeminal neuralgia may have these symptoms:

• Flashes of severe pain in the cheek or jaw, rarely on both sides
• The pain feels like electric shocks or like a knife
• Pain is often triggered by wind or touching, eating, or brushing your teeth
• Anxiety from the thought of the pain returning

Your healthcare provider will ask about your health history and give you a physical and neurological exam. Tell your provider details about your pain, such as the location, intensity, and description of the pain. This may help with making a diagnosis. Imaging tests such as an MRI may be used to look for other causes of pain such as from a tumor or multiple sclerosis.

Most common over-the-counter and prescription pain medicines don’t work for the pain from this condition. Treatment may include:

• Anticonvulsant medicine
• Tricyclic antidepressants
• Lidocaine (intranasal spray or intravenous)
• Surgery, if medicine doesn’t work
• Acupuncture
• Biofeedback
• Stereotactic radiosurgery
• Percutaneous balloon rhizotomy
• Radiofrequency ablation
• Glycerol injection

This condition is not life-threatening. But the pain and anticipation of the pain can interfere with your life. Working closely with your healthcare provider will help you find the best pain management methods for you. Alternative therapies have also been shown to help. Some of these include:

• Acupuncture
• Vitamin and nutritional therapy
• Botulinum injections
• Chiropractic treatments
• Biofeedback

You may find that certain activities seem to trigger the pain more than others. Over the next few weeks, keep a pain diary. Write down when your symptoms happen and how they feel. Certain activities, such as touching your face, chewing, talking, or brushing your teeth, may bring on the pain. Cold air can also trigger the pain. Make sure you write down any triggers and discuss these with your provider. This will help guide treatment.

Call your healthcare provider or get medical care right away if you have any of these:

• Fever of 100.4°F (38°C) or higher
• Headache with very stiff neck
• Repeated vomiting
• Extreme drowsiness or confusion
• Dizziness or fainting
• A new feeling of weakness or numbness or tingling in your arm, leg, or face
• Trouble speaking or seeing