What Is Trigeminal Neuralgia?
The trigeminal nerve carries signals between the brain and the face. Trigeminal neuralgia (TN) is a painful condition in which this nerve becomes irritated.
The trigeminal nerve is one of 12 sets of cranial nerves. It’s responsible for sending feeling or sensation from the brain to the face. The trigeminal nerve is actually a pair of nerves: one extends along the left side of the face, and one runs along the right side. Each of those nerves has three branches, which is why it’s called the trigeminal nerve.
Symptoms of trigeminal neuralgia range from a constant ache to a sudden intense stabbing pain in the jaw or face. Pain can be triggered by something as simple as washing your face, brushing your teeth, or talking. Some people feel warning signs like tingling or achiness prior to onset of pain. The pain may feel like an electric shock or a burning sensation. It can last anywhere from a few seconds to several minutes. In severe cases, it may last as long as an hour.
An early symptom of multiple sclerosis
About half of people with multiple sclerosis (MS) experience chronic pain, according to the National Multiple Sclerosis Society. Trigeminal neuralgia can be a source of extreme pain for people with MS, and it’s known to be an early symptom of the condition.
The American Association of Neurological Surgeons (AANS) says that MS is usually the cause of trigeminal neuralgia in young adults. Trigeminal neuralgia occurs more often in women than men, which is also the case with MS.
Typically, symptoms of TN come in waves and are followed by periods of remission. For some people, trigeminal neuralgia becomes a progressive condition with increasingly shorter periods of remission between painful attacks.
Causes and prevalence
MS causes damage to myelin, the protective coating around nerve cells. Trigeminal neuralgia may be caused by myelin deterioration or the formation of lesions around the trigeminal nerve.
In addition to MS, trigeminal neuralgia may be caused by a blood vessel pressing on the nerve. Infrequently, trigeminal neuralgia is caused by a tumor, tangled arteries, or injury to the nerve. Facial pain can also be due to temporomandibular joint disorder or cluster headaches, and sometimes follows an outbreak of shingles
More than 100,000 people are diagnosed with trigeminal neuralgia every year, according to AANS. It appears more often in older adults, but can occur at any age.
Diagnosing trigeminal neuralgia
You should report new pain to your doctor. New symptoms aren’t always due to MS, so other causes must be ruled out.
The site of the pain can help diagnose the problem. Your doctor will perform a comprehensive neurological exam and most likely order an MRI screening to help pinpoint the cause.
Treatment for trigeminal neuralgia usually starts with medications. The most common drug prescribed for the condition is carbamazepine, according to the AANS. It helps control the pain, but it becomes less effective the more it’s used. If carbamazepine doesn’t work, the source of the pain may not be trigeminal neuralgia.
Another commonly used medication is baclofen. It relaxes the muscles to help ease the pain. The two drugs are sometimes used together.
If medications aren’t enough to control the pain of trigeminal neuralgia, surgery may be necessary. Several types of operations are available. The most common type, microvascular decompression, involves moving a blood vessel away from the trigeminal nerve. When it’s no longer pushing against the nerve, the pain may subside. Any nerve damage that occurred may be reversed.
Radiosurgery is the least invasive type. It involves the use of beams of radiation to try to block the nerve from sending pain signals.
Other options are using gamma knife radiation or injecting glycerol to numb the nerve. Your doctor can also use a catheter to inject a balloon to damage the nerve or send an electric current to damage nerve fibers.
Other types of pain associated with MS
Faulty sensory signals can cause other types of pain in people with MS. Some experience burning pain and sensitivity to touch, usually in the legs. Neck and back pain can result from wear and tear or from immobility. Repeated steroid therapy can result in shoulder and hip problems.
Regular exercise, including stretching, can ease some types of pain.
You should always report any new pain to your doctor so underlying problems can be identified and treated.
Trigeminal neuralgia is a painful condition that currently has no cure. However, its symptoms can often be managed. A combination of medications and surgical options can often make the pain tolerable.
Support groups can help you learn more about new treatments and ways to cope. Alternative therapies, such as hypnosis, acupuncture, meditation, and yoga, may also help ease the pain.