Trigeminal Neuralgia: Symptoms, Causes & Treatment

What is it:

Trigeminal neuralgia is a neurological condition characterized by compression of the trigeminal nerve. This nerve controls the muscles required for chewing, and is also responsible for the transmission of sensory information from the face to the brain. Compression can cause pain, mainly in the lower face, which can radiate to areas surrounding the nose and eyes. 

Flare-ups of trigeminal neuralgia are very painful and can be triggered by simple occurrences, like touching your face, eating, or brushing your teeth. 

Although there is no cure for this condition, flare-ups can be managed with medications as prescribed by the doctor. Treatment will depend on each patient’s health history and the intensity of symptoms. Treatment goals are aimed toward improving quality of life. 

Common symptoms

Symptoms of trigeminal neuralgia can be triggered by any movement that can lead to compression of the trigeminal nerve, like brushing you teeth, chewing, smiling, speaking or washing your face. Symptoms will depend on the specific area where the nerve is compromised, but can include:

• Pain in the lips, gums, cheeks, or chin which causes difficulty with chewing 
• Eye or forehead pain 
• Sudden, shocking pain that appears on the face even with slight movements, like touching your face or applying makeup 
• A feeling of heat along the nerve 
• Tingling in the affected region 

In addition to pain, you may also experience changes to sensitivity in the area. 

Generally, flare-ups will last for a few seconds or minutes and feel like an electric shock. Pain can be very intense, and is usually located on a specific area of the face, although it can radiate throughout the dace. In some cases, people may experience pain for several days, causing severe pain and discomfort. Therefore, it is essential to seek assessment from a neurologist to ensure symptoms are adequately managed. 

How it is diagnosed 

Diagnosis of trigeminal neuralgia is confirmed by a family doctor or neurologist by assessing the signs and symptoms the patient is presenting with. The doctor will usually order diagnostic imaging, like an MRI or X-ray to determine whether there is a serious underlying cause for the pain, like a tooth infection, a tooth fracture or a tumor. 

What causes it 

Pain is usually triggered by the compression of the trigeminal nerve. It most commonly happens due to the dislocation of a blood vessel that innervates and compresses the nerve.  

Trigeminal neuralgia can also occur in people with brain lesions, or in those that suffer from an autoimmune disease that affects the nerves, like multiple sclerosis. With multiple sclerosis, the myelin sheath of the trigeminal nerve can start to dissolve and wear down, causing mal-functioning of the nerve. 

Pain can also occurs as a surgical complication, from medication use, from direct trauma to the head, or with decreased circulation in the area. 

How it is treated 

Although there is no cure, trigeminal neuralgia flare-ups can be controlled to promote optimal quality of life. Depending on the severity, the doctor may recommend medications, physiotherapy and even surgery to help with nerve functioning. 

The main treatment options for trigeminal neuralgia include: 

1. Medications

Medications are usually the first-line of treatment. The doctor may prescribe:

• Analgesics, like acetaminophen
• Anticonvulsants, like carbamazepine, gabapentin or lamotrigine 
• Muscle relaxants, like cyclobenzaprine
• Antidepressants, like amitriptyline or nortriptyline

Medications are usually recommended to manage nerve irritation and to decrease associated symptoms. 

2. Physiotherapy 

Physiotherapy can be done by using electrostimulation. This involves the use of small, electric shocks on the face to control nerve sensitivity and relieve pain. 

3. Surgery

Surgery is recommended when treatment with medication is not effective or when the pain is very intense. There are 3 types of procedures that can be considered: 

• Glycerol injections to the branches of the trigeminal nerve to block function of the nerve 
• Radiofrequency heat applied to the nerve to burn it and provide pain relief 
• Surgical removal of the tumor or vessel causing compression

Some doctors may recommend a balloon technique, in which a balloon is inflated at the nerve roots for one minute, which interrupts blood flow and leads to pain relief. 

4. Natural options

A natural way to relieve pain can include applying a towel soaked in warm water and salt behind the neck to reduce swelling of the nerve. Another option is to apply cayenne pepper mixed with olive oil or facial cream directly to the affected region.