Trigeminal neuralgia: the most intense facial pain and how it can be treated

Many specialists consider trigeminal neuralgia one of the most intense pains there is. Recognizing it saves years of dental or sinus treatments that do not solve the problem.

What is trigeminal neuralgia?

It is a very intense facial pain caused by a problem with the trigeminal nerve, the main nerve responsible for sensation in the face. It comes in sudden episodes that last seconds, almost always on one side of the face.

Which areas of the face does it affect?

The nerve has three branches: the forehead and the area around the eye; the cheek and upper lip; and the lower lip and chin. The pain can appear in any of them, although it is more common on the right side and in the middle and lower branches.

What is the pain like?

It starts and stops abruptly, lasts only seconds and can repeat in bursts. It is described as an electric shock, a whiplash, a stab or a sudden burn. Between episodes many people have no pain, although over time a background ache may remain.

What triggers the attacks?

So-called trigger zones: touching certain parts of the face, chewing, talking, brushing your teeth or even a breeze. For fear of setting off an episode, many patients stop eating properly, washing or socializing.

What causes trigeminal neuralgia?

In adults, the most common cause is a blood vessel pressing on the nerve where it enters the brainstem. Over time that pressure damages the nerve's covering and disrupts how it transmits signals. Less often it is related to multiple sclerosis or other lesions along the nerve's path.

How is it diagnosed?

Mainly from the features of the pain the patient describes. An MRI with specific sequences shows the relationship between the nerve and nearby vessels, which helps confirm the diagnosis and plan treatment.

How is it treated?

1. Medication: anticonvulsants are the first treatment and control the episodes in many patients.
2. Percutaneous procedures on the nerve, when medication is not enough.
3. Microvascular decompression surgery, which moves the vessel pressing on the nerve away and addresses the cause of the pain.

In summary

Trigeminal neuralgia can be treated. An evaluation with a neurosurgeon lets you know all the options and recover the quality of life this pain can take away.

This article is for information only and does not replace a medical visit. If you have warning signs, go to the emergency room.