A patient who presents with facial pain when the face is touched, putting makeup on, or even brushing teeth, could have trigeminal neuralgia (TN). The condition is affects the trigeminal nerve that carries nerve impulses from the facial area to the brain. If there is something aggravating this nerve, it will cause abnormal pain sensations to the person affected.
The attacks may be short and mild initially, but the longer it progresses, it could become very painful and frequent. Patients describe it as a searing pain. Trigeminal neuralgia affect women more than men, and people who are older than 50 years of age.
A person may experience one or more of these symptoms:
• Bouts of pain lasting a few seconds or several seconds.
• Pain in cheek, lips, gums, teeth, jaw, or possibly the eye or forehead.
• Attacks become more frequent and worse as time passes on.
• Frequent attacks lasting days or longer; some people may have periods without pain
• Attacks triggered by touching the face, chewing, talking, or brushing teeth.
• Severe pain characterized as shooting or jabbing.
• Pain on one side of the face at a time.
• Pain focused in one area.
If the pain is unrelieved by analgesics like acetaminophen or other over-the-counter pain relievers, make an appointment with the doctor.
Causes of TN may be from the nerve’s function being disrupted. This can be from a normal blood vessel putting pressure on the nerve and causing a problem with its communication with the brain. Another cause of trigeminal neuralgia is aging, or it could be related to multiple sclerosis or other type of disorder that damages the myelin sheath that protects certain nerves. Other issues that are less common are tumors or brain lesions. Sometimes, the cause is unknown.
A trigeminal neuralgia diagnosis is derived from the patient’s medical history. Identifying what symptoms the patient is experiencing as well as physical and neurological tests will help determine whether it is TN. Other disorders of the face will need to be ruled out first, however. There could be an overlapping of symptoms with other facial disorders, such as temporomandibular joint disorder (TMJ) where the pain is in the jaw joint. Because of this overlapping and the large number of facial pain problems that exist, getting the correct diagnosis may prove difficult. It is essential to find the correct diagnosis, however, to provide the proper treatment.
Patients with trigeminal neuralgia will have a magnetic resonance imaging (MRI) scan to check for tumor or multiple sclerosis so that these can be ruled out as causing the facial pain. The scan may show if a blood vessel is pressing into the nerve but not always.
It has been found that if a patient responds favorably to taking a short course of an antiseizure medication for treatment of TN, this confirms the diagnosis. A diagnosis of classic trigeminal neuralgia may be supported by an individual’s positive response to a short course of an antiseizure medication.
If it has been confirmed that the patient has TN, there are some treatment options. One is a nerve block or trigeminal block. There are many regions that the nerve block may be done. This treatment will reduce or eliminate the pain from TN.