Trigeminal neuralgia: the cheek of the nerve

Not many people had ever heard of the condition trigeminal neuralgia until popular Bollywood celebrity Salman Khan got affected by it. A horde of news reports followed and the disorder suddenly came into limelight. Still, many people are unclear about what exactly it is and other aspects related to it.

What is trigeminal neuralgia?

Trigeminal neuralgia [TN] is a condition characterised by intermittent, sharp, shooting pain usually affecting one side of the face. The condition affects the trigeminal nerve that transmits sensations such as hot or cold temperature, touch and pain from the face to the brain. It does not lead to death or paralysis or any physical disability.

How common is TN and who gets affected by it?

TN is an uncommon condition occurring mostly after age 50 and affecting women more than men. It may affect younger people too, but rarely.

What are the signs of TN?

• Those suffering from TN usually complain of sharp, shooting pain affecting one side of their faces. Pain is located in the middle and lower parts of the face. The upper part may be affected but in rare cases. In about 10 per cent patients, the pain may occur on both sides of the face.
• Pain may also occur in the lips, gums, teeth, eye, ear, forehead or cheeks.
• It is described as a lancinating pain or as an electric-shock like sensation.
• Pain often lasts a few seconds. It recurs several times in a week and sometimes several times in a day.
• Patients are often normal in between the pain attacks.
• There may be relative periods of improvement lasting for a few months.
• Simple activities like brushing teeth, washing face, chewing food, shaving or even a draft of air from an AC or fan aggravates the pain.
• The pain is severe and repetitive and hampers normal life. Many patients experience problems performing daily jobs due to the pain.

TN, if left untreated, may become chronic and persist for several years.

How is it diagnosed?

TN is diagnosed on the basis of clinical description of facial pain. However, your neurologist may ask for an MRI along with MR angiogram of the brain to rule out other causes. In cases of TN, most clinical examination findings are normal [except for mild numbness over the face in some cases].

There are chances of TN getting misdiagnosed as the pain seems to arise from the tooth rather than the face. This is because the trigeminal nerve is connected to that region as well. So, people often visit a dentist in the initial stages of symptoms. However, the pain persists even after dental treatment [if any required]. Occasionally, some people visit an ENT surgeon as sometimes the pain seems to arise from behind the ear.

What causes it?

There are several patients suffering from TN with no specific cause. However, in many patients, there could be secondary causes that can be easily identified on the brain scan. These include:

• Compression over the trigeminal nerve by a blood vessel
• Multiple sclerosis [a condition affecting the brain and the spinal cord, where the covering of the nerve is damaged]
• Cystic growths [which contain fluid]
• Non-cancerous tumours
• Infections in the region of trigeminal nerve.

How do we treat TN?

TN is usually treated with medications, which include simple analgesics to relieve the pain. Drugs are started at a low dose, and the dose is modified depending on the response and side-effects.

More than half the patients do well with medical treatment and are pain-free after treatment. However, some patients do not respond to medicines or experience significant adverse effects such as drowsiness, dizziness, imbalance or skin rashes. These patients are then treated by other methods.

What are the other treatments?

• Radio-frequency ablation in which a part of the nerve is removed using lasers. This procedure is carried out by a radiation therapist in consultation with a neurosurgeon.
• Anaesthetics are injected into the nerve to numb the pain. This procedure is carried out by anaesthetists.
• Gamma knife radiosurgery, which uses radiation to erode the affected part of the nerve.
• Microvascular decompression. It is a surgical procedure where the trigeminal nerve is freed/released from any compression by a vessel or other surrounding tissues. This procedure is performed by a neurosurgeon.

This was first published in the March 2012 issue of Complete Wellbeing

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