Trigeminal neuralgia: Symptoms, causes, and treatment
Neuralgia refers to severe pain along the course of a nerve, due to nerve irritation or damage. Trigeminal neuralgia affects the trigeminal nerve, one of the most wide-reaching nerves in the head. It is thought to affect about one million people worldwide.
Trigeminal neuralgia is a type of non-nociceptive pain (Non-nociceptive pain results from damage or irritation to the nerves or a fault in the nervous system. The nerves themselves are sending pain messages to the brain).
People with neuralgia describe it as a short-lived but intense burning or stabbing pain. It may feel as if the pain is shooting along the course of the affected nerve. Although the pain is brief, trigeminal neuralgia is a chronic condition, which gets worse in time. Bouts of pain can last a few minutes, usually on one side of the face. Trigeminal neuralgia is twice as common in women than men, and it is more likely after the age of 50 years.
One or more of the following symptoms may occur:
- intermittent twinges of mild pain lasting from a few seconds to several minutes
- severe episodes of searing, shooting, jabbing pain that feel like electric shocks
- sudden attacks of pain triggered by stimuli that are usually not painful, such as by touching the face, chewing, speaking, or brushing the teeth
- spasms of pain which last from a couple of seconds to a couple of minutes
- episodes of cluster attacks, which may last much longer, but between them, there may be no pain
- pain wherever the trigeminal nerve and its branches may reach, including the forehead, eyes, lips, gums, teeth, jaw, and cheek
- pain in one side of the face, or, less frequently, both sides
- pain that is focused in one spot or spreads in a wider pattern
- attacks of pain that occur more regularly and intensely over time
- tingling or numbness in the face before pain develops
Attacks of pain may occur hundreds of times each day in severe cases. Some patients may have no symptoms for months or years between attacks.
Area of pain
The area of pain will be based on the three branches of the trigeminal nerve:
- Ophthalmic: Affects the forehead, nose, and eyes
- Maxillary: Affects the lower eyelid, side of nose, cheek, gum, lip, and upper teeth
- Mandibular: Affects the jaw, lower teeth, gum, and lower lip
Trigeminal neuralgia sometimes affects more than one branch at a time.
Atypical trigeminal neuralgia
Atypical trigeminal neuralgia is a variation on typical trigeminal neuralgia. Pain may be described as burning, aching, or cramping, rather than sharp or stabbing.
It may occur on one side of the face, often in the region of the trigeminal nerve, and can extend into the upper neck or the back of the scalp. The pain can fluctuate in intensity from a mild ache to a crushing or burning sensation.
The atypical presentation of trigeminal neuralgia is harder to diagnose.
The main cause of trigeminal neuralgia is blood vessels pressing on the root of the trigeminal nerve.
This makes the nerve transmit pain signals that are experienced as stabbing pains. Pressure on this nerve may also be caused by a tumor or multiple sclerosis (MS).
Other causes may include:
- Multiple sclerosis: This is due to demyelinization of the nerve. Trigeminal neuralgia typically appears in the advanced stages of multiple sclerosis.
- A tumor presses against the trigeminal nerve: This is a rare cause.
- Physical damage to the nerve: This could be the result of injury, a dental or surgical procedure, or infection.
- Family history: The formation of blood vessels is inherited.