- Home
- Neuropathic Pain – Trigeminal Neuralgia
What is trigeminal neuralgia?
Trigeminal neuralgia, also known as tic douloureux, is a chronic pain condition that affects the trigeminal nerve, which carries sensation from your face to your brain. It is characterised by intense, sharp, electric-like pain on one side of the face, typically in the areas of the jaw, cheek, or near the eye. The pain can be triggered by routine activities such as eating, talking, or touching the face. The exact cause of trigeminal neuralgia is not always clear, but it is often associated with the compression of the trigeminal nerve by a blood vessel.
What causes trigeminal neuralgia?
Trigeminal neuralgia is primarily caused by trigeminal nerve compression, often by a blood vessel that presses against the nerve as it exits the brainstem. This compression can damage the nerve’s protective sheath (myelin) and lead to episodes of intense pain. Other causes and factors that may contribute to the development of trigeminal neuralgia include:
- Arteriovenous malformations: these are abnormal connections between arteries and veins, which can compress the trigeminal nerve in rare cases.
- Brain lesions or other abnormalities: brain lesions can affect the trigeminal nerve.
- Surgical injuries or facial trauma: previous surgeries or injuries to the face may damage the trigeminal nerve.
- Tumours: a tumour pressing against the trigeminal nerve can cause symptoms.
However, in many cases, the exact cause of trigeminal neuralgia cannot be determined, and it is classified as idiopathic.
What are the symptoms of trigeminal neuralgia?
Symptoms of trigeminal neuralgia are distinct and can be quite severe. Trigeminal neuralgia symptoms typically include:
- Sudden, severe pain: trigeminal neuralgia pain is often described as a sharp, shooting, or electric shock-like pain in the face. It usually occurs on one side of the face, along the distribution of the trigeminal nerve, affecting the forehead, cheek, jaw, or even the area around the nose and above the eye.
- Triggered by routine activities: the pain can be triggered by everyday activities such as eating, speaking, brushing teeth, touching the face, or even a slight breeze.
- Episodes of pain: the pain can occur in sudden, short (from a few seconds to about two minutes), and intense bursts. These episodes can occur in quick succession over hours or even days.
- Pain-free intervals: between attacks, there may be periods of no pain or a slight tingling sensation in the affected area.
- Facial twitching or spasms: in severe cases, the pain can lead to involuntary twitching or spasms of the facial muscles, known as tic convulsif.
- Effect on daily life: due to the intensity and unpredictability of the pain, trigeminal neuralgia can significantly impact a person’s quality of life, which may even lead to anxiety or depression in some cases.
The pain of trigeminal neuralgia is typically one-sided and does not cross over the midline of the face. It is known for being one of the most severe forms of pain that can be experienced.
Who is at risk of trigeminal neuralgia in Singapore?
The risk factors for trigeminal neuralgia include:
- Ageing: the risk of developing trigeminal neuralgia increases with age, possibly due to changes in blood vessels and the gradual wear and tear on the body’s nerves and tissues.
- Multiple sclerosis (MS): in people with MS, the deterioration of the myelin sheath, which covers nerves, can lead to trigeminal neuralgia.
- Gender: women are more likely to develop trigeminal neuralgia than men.
- Hypertension: some evidence suggests that high blood pressure might be associated with an increased risk of developing trigeminal neuralgia, although the link is not entirely clear.
How is trigeminal neuralgia diagnosed?
Trigeminal neuralgia is diagnosed primarily through clinical evaluation based on the patient’s history and symptoms. Here’s how the diagnosis of trigeminal neuralgia typically unfolds:
- Medical history and symptom description: the diagnosis starts with a detailed discussion of the symptoms, including the nature of the pain, its location, triggers, duration, and any factors that provide relief. The distinctive nature of the pain in trigeminal neuralgia — sudden, sharp, and triggered by everyday activities — is often a key indicator.
- Physical examination: your pain specialist may conduct a physical exam, focusing on the face to identify the affected areas and to test for sensory differences or reflexes. They may also try to trigger the pain to observe its characteristics while being careful not to cause excessive discomfort.
- Neurological examination: a detailed neurological examination can help rule out other conditions that might cause facial pain. This examination checks for sensory abnormalities and reflexes in different parts of the face.
- Magnetic resonance imaging (MRI): an MRI scan can help to identify if there is a structural cause for the pain, such as a blood vessel pressing against the trigeminal nerve, tumours, or multiple sclerosis plaques affecting the nerve’s pathway. The use of a specialised MRI technique known as magnetic resonance angiography (MRA) can provide detailed images of blood vessels. It may help to identify any compression of the trigeminal nerve.
The diagnosis of trigeminal neuralgia primarily relies on the patient’s description of symptoms and clinical findings.
What are the treatment options for trigeminal neuralgia in Singapore?
The treatment of trigeminal neuralgia typically involves a combination of medication, surgery, and other therapies aimed at relieving pain and preventing future attacks. Here are the main treatment options for trigeminal neuralgia:
- Medications:
- Anticonvulsants: drugs like carbamazepine and oxcarbazepine are the first line of treatment. They help to reduce nerve firing and alleviate pain.
- Muscle relaxants: medications such as baclofen may be used alone or in combination with anticonvulsants.
- Other pain relievers: in some cases, different types of pain medication, including non-steroidal anti-inflammatory drugs (NSAIDs), may be used for short-term pain relief.
- Treatment options:
- Radiofrequency ablation: radiofrequency ablation is a minimally invasive procedure that involves damaging the nerve fibres to block pain signals.
- Microvascular decompression (MVD): this surgery involves relocating or removing blood vessels compressing the trigeminal nerve. It has a high success rate for pain relief.
- Stereotactic radiosurgery (gamma knife surgery): this procedure uses focused radiation to target and damage the trigeminal nerve, reducing pain signals.
The treatment choice depends on the severity of the symptoms, the individual’s overall health, and how well they respond to initial treatments. Treatment plans often need to be tailored to the individual, and it may take some time to find the most effective approach. If you are suffering from trigeminal neuralgia, please schedule an appointment with us for a thorough diagnosis and an appropriate treatment plan.
Frequently asked questions
Yes, trigeminal neuralgia can lead to complications like chronic sleep disruption, anxiety, depression, and a reduced quality of life due to the constant fear of pain and the limitations it imposes.
Trigeminal neuralgia is not typically progressive in the sense of worsening over time. Still, its episodes can increase in frequency and severity if untreated, which can result in more persistent pain and discomfort.
While rare, trigeminal neuralgia can affect both sides of the face, but usually not simultaneously. Bilateral trigeminal neuralgia occurs in a small percentage of patients and can be more challenging to treat.
Management of trigeminal neuralgia during pregnancy focuses on non-pharmacological treatments to avoid risks to the fetus, with medications used cautiously and only when necessary, under close medical supervision.
Total Pain Specialist