The trigeminal nerve carries signals between the brain and the face. Trigeminal neuralgia (TN) is a painful condition in which this nerve becomes irritated.
Symptoms of TN range from a constant ache to a sudden intense stabbing pain in the jaw or face. Pain can be triggered by something as simple as washing your face, brushing your teeth, or talking. Some people feel warning signs like tingling or achiness prior to onset of pain. The pain may feel like an electric shock or a burning sensation. It can last anywhere from a few seconds to several minutes. In severe cases, it may last as long as an hour.
About half of people with multiple sclerosis (MS) suffer from chronic pain, according to the National Multiple Sclerosis Society. Trigeminal neuralgia can be a source of extreme pain in MS patients, and is known to be an early symptom of the condition.
The American Association of Neurological Surgeons (AANS) says that MS is usually the cause of trigeminal neuralgia in young adults. Trigeminal neuralgia occurs more often in women than men, which is also the case with MS.
Typically, symptoms of TN come in waves and are followed by periods of remission. For some people, TN becomes a progressive condition with increasingly shorter periods of remission between painful attacks.
The trigeminal nerve is one of 12 sets of cranial nerves. It’s responsible for sending feeling or sensation from the brain to the face. The trigeminal nerve is actually a pair of nerves: one extends along the left side of the face, and one runs along the right side. Each of those nerves has three branches, which is why it’s called the “tri”geminal nerve.
MS causes damage to myelin, the protective coating around nerve cells. TN may be caused by myelin deterioration or the formation of lesions around the trigeminal nerve.
In addition to MS, TN may be caused by a blood vessel pressing on the nerve. Infrequently, TN is caused by a tumor, tangled arteries, or injury to the nerve. Facial pain can also be due to temporomandibular joint disorder (TMJ) or cluster headaches, and sometimes follows an outbreak of shingles
More than 100,000 people are diagnosed with trigeminal neuralgia every year, according to AANS. It appears more often in older adults, but can occur at any age.
You should report new pain to your doctor. New symptoms aren’t always due to MS, so other causes must be ruled out.
The site of the pain can help diagnose the problem. Your doctor will perform a comprehensive neurological exam and probably order a magnetic resonance imaging (MRI) screening to help pinpoint the cause.
Treatment for trigeminal neuralgia usually starts with medications. The most common drug prescribed for the condition is carbamazepine, according to the American Association of Neurological Surgeons. It helps control the pain, but becomes less effective the more it’s used.
Another commonly used medication is baclofen. It relaxes the muscles to help ease the pain. The two drugs are sometimes used together. If carbamazepine doesn’t work, the source of the pain may not be trigeminal neuralgia.
If medications aren’t enough to control the pain of trigeminal neuralgia, surgery may be necessary. Several types of operations are available. The most common type, microvascular decompression, involves moving a blood vessel away from the trigeminal nerve. When it is no longer pushing against the nerve, the pain may subside. Any nerve damage that occurred may be reversed.
Radiosurgery is the least invasive type. It involves the use of beams of radiation to try to block the nerve from sending pain signals.
Other options are using gamma knife radiation or injecting alcohol or glycerol to numb the nerve. Your doctor can also use a catheter to inject a balloon to damage the nerve or send an electric current to damage nerve fibers.
Faulty sensory signals can cause other types of pain in people with MS. Some experience burning pain and sensitivity to touch, usually in the legs. Neck and back pain can result from wear and tear or from immobility. Repeated steroid therapy can result in shoulder and hip problems.
Regular exercise, including stretching, can ease some types of pain. When you live with a chronic illness like MS, it’s tempting to blame new symptoms on the MS. However, you should report pain to your doctor so other problems can be identified and treated.
Trigeminal neuralgia is a painful condition that currently has no cure. However, its symptoms can often be managed. A combination of medications and surgical options can often make the pain tolerable.