Understanding trigeminal neuralgia

The trigeminal nerve carries signals between the brain and the face. Trigeminal neuralgia (TN) is a painful condition in which this nerve becomes irritated.

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 trigeminal nerve.

Symptoms of TN range from a constant ache to a sudden intense stabbing pain in the jaw or face.

Pain from TN can be triggered by something as simple as washing your face, brushing your teeth, or talking. Some people feel warning signs such as tingling, achiness, or earache prior to the 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.

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.

About half of people with multiple sclerosis (MS) experience chronic pain, according to the National Multiple Sclerosis Society. TN can be a source of extreme pain for people with MS, and it’s known to be an early symptom of the condition.

The American Association of Neurological Surgeons (AANS) says that MS is usually the cause of TN in young adults. TN occurs more often in women than men, which is also the case with MS.

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 (TMJ) disorder or cluster headaches, and sometimes follows an outbreak of shingles.

Around 12 people out of every 100,000 in the United States receive a TN diagnosis each year, according to the National Institute of Neurological Disorders and Stroke. TN appears more often in adults over 50, but it can occur at any age.

If you have MS, you should always 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 most likely order an MRI screening to help pinpoint the cause.

Treatment for TN usually starts with medications.

According to the AANS, the most common drug prescribed for the condition is carbamazepine (Tegretol, Epitol). It helps control the pain, but it becomes less effective the more it’s used. If carbamazepine doesn’t work, the source of the pain may not be TN.

Another commonly used medication is baclofen. It relaxes the muscles to help ease the pain. The two drugs are sometimes used together.

If medications aren’t enough to control the pain of TN, 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’s 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 include using gamma knife radiation or injecting glycerol to numb the nerve. Your doctor can also use a catheter to place a balloon in the trigeminal nerve. The balloon is then inflated, compressing the nerve and injuring the fibers that cause pain. Your doctor can also use a catheter to send an electric current to damage nerve fibers that are causing pain.

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.

Remember to report any new pain to your doctor so that underlying problems can be identified and treated.

TN is a painful condition that currently has no cure. However, its symptoms can often be managed. A combination of medications and surgical options can help relieve the pain.

Support groups can help you learn more about new treatments and ways to cope. Alternative therapies may also help ease the pain. Therapies to try include: