Trigeminal Neuralgia

Trigeminal neuralgia is a nerve-pain condition with sudden, brief, shock-like pain in the face — along the territory of the trigeminal nerve (cheek, jaw, eye). It is severe enough to be called "suicide disease" in older literature. It is treatable; life is substantially better with the right diagnosis.

Features

• Sharp, electric, stabbing pain lasting seconds to 2 minutes.
• One side of the face — cheek, jaw, around the eye, forehead.
• Triggered by light touch, talking, chewing, brushing teeth, cold wind, shaving.
• Pain-free periods between episodes, which can stretch to months, then flare again.
• Some develop constant background ache (atypical trigeminal neuralgia).

Possible causes

• Blood-vessel compression of the nerve near the brainstem — commonest.
• Multiple sclerosis — in younger patients.
• Tumours pressing on the nerve — uncommon.
• Herpes zoster (shingles) leaves post-herpetic pain in that territory — related but distinct.
• Dental or sinus problems — can mimic; always rule out.

Diagnosis

• Clinical history is highly suggestive.
• MRI brain — identifies vessel loop, MS plaques, rarely tumours.
• Dental examination rules out tooth causes.

Treatment

• Anti-epileptic medicines — first-line; highly effective for most.
• Other medicines if intolerance or resistance — several second-line options under neurology guidance.
• Surgery — microvascular decompression — for drug-resistant or poorly tolerated medicines; excellent long-term results in suitable cases.
• Less invasive procedures — radiofrequency, glycerol injection, balloon compression, stereotactic radiosurgery (Gamma Knife) — at specialised centres.
• Don't accept months of severe pain without neurology referral — this is one of the most effectively treatable pain conditions in medicine.