Trigeminal Neuralgia is an extremely severe facial pain that tends to come and go unpredictably in sudden shock-like attacks.. It presents as a sudden onset severe shooting or burning facial pain that can occur spontaneously and may last for a few seconds or as consistent short bursts over a number of hours. The pain is normally triggered by light touch, or muscle movement, and can even be stimulated by a gentle breeze on the skin and is described as stabbing, shooting, excruciating or burning.
The Trigeminal nerve splits into three sections, the first running above the eye and forehead, the second running along the cheek, side of the nose and teeth of the upper jaw, and the third which involves the lower jaw and teeth. Although Trigeminal Neuralgia can involve any of the three branches, it often affects the second and third branches. Unfortunately, for most sufferers, the condition is progressive and will worsen over time.
The pain is most commonly felt on one side of the face (unilateral) and usually in the cheek or lower jaw. There may also be pain inside the mouth and often it can feel as if it is coming from one or more teeth, hence many people seek the help of their dentist initially. In other instances, pain can be felt on the entire side of the face or, occasionally, just around the eye and forehead. Trigeminal neuralgia tends to affect the right side of the face more than the left side. Very rarely, it can occur on both sides (this is known as bilateral) but it is rare to have acute pain on both sides at the same time.
You can view a short video overview by Mr Jonathon Hyam below.
What are the causes
It is now generally agreed that the trigeminal nerve is ‘misfiring’ and is sending out inappropriate pain signals. The myelin sheath can be damaged by pressure from blood vessels (veins or arteries), multiple sclerosis (MS), injury to the nerve or simply as part of the ageing process. In a small number of cases, the cause may be due to a tumour or a benign growth pressing on the nerve.
When the nerve is injured it becomes ‘hyper-excited’. The result is that the nerve fibres inside the nerve itself fire off signals of pain at the least provocation.
Trigeminal neuralgia is thought to affect 8 in 100,000 people, and women appear to be more susceptible. Presentation often occurs in middle age, but in rare cases can begin in younger adults.
The initial diagnosis can be made by your GP or dentist. It is crucial to give a thorough description of the pain. If Trigeminal neuralgia is suspected, you will need to see a neurologist, oral physician or pain specialist. An MRI scan is usually done to ascertain if there is an obvious cause for the pain and also to rule out other conditions. As there is no diagnostic test for Trigeminal neuralgia , the procedure of diagnosis may take some time and require persistence. Diagnosis falls into two categories:
Classic Trigeminal neuralgia: This is typically caused by a blood vessel or vessels compressing the trigeminal nerve as it enters the brainstem. The loss of the myelin sheath surrounding the nerve will have been caused by the constant rubbing and pulsating of the blood vessel(s), causing erratic messages to be transmitted along the wrong nerve fibres, ie, “cross talk” between light touch and pain fibres.
Symptomatic Trigeminal Neuralgia where it is secondary to an underlying cause such as Multiple Sclerosis which may also result in the demyelination of one or more branches of the trigeminal nerve or other rare diseases which cause damage to the myelin sheath such as benign cysts, a tumour compressing the trigeminal nerve, abnormalities at the base of the skull or arteriovenous malformations, ie, abnormal blood vessels.Only a very few trigeminal neuralgia cases are caused by one of these underlying medical conditions.
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