Trigeminal neuralgia: the facts
What is it?
The trigeminal nerve, which should transmit appropriate pain messages, has three branches on each side of the face: one above the eyes and across the forehead; another through the cheek, upper jaw, teeth, gums and side of the nose; and the third through the lower jaw, teeth and gums. Malfunctioning pain messages most often come from the middle and lower branches.
Dr Motasem Alyacoub, consultant neurologist, American Hospital, says he’s treated around 300 patients with the condition over the past 20 years. It’s an uncommon illness that usually affects the elderly, because as people age, blood vessels lengthen and can rest on and pulsate against a nerve.
“More than 80 per cent of the patients I have seen were over the age of 60, fewer than 5 per cent of patients were under the age of 40 and the rest were between 40 and 60 years,” says Dr Alyacoub.
What causes it?
It’s unclear what causes most cases of trigeminal neuralgia. Most likely is damage to the myelin sheath around the nerve, which can happen through pressure from arteries or blood vessels, sometimes from tumours or multiple sclerosis.
Conditions believed to lead to trigeminal neuralgia include a blood vessel compressing the nerve, viral infection, dental procedures and benign tumours, Dr Alyacoub says.
What are the symptoms?
Sudden pain often described as electric shocks, or stabbing and burning, most often on the right side of the face.
How is it treated?
Anticonvulsant drugs are usually tried first to soothe the nervous system. Sometimes antidepressants may help quieten the nervous system. Normal painkillers often prove ineffective. Injections of glycerol through the cheek, or radiation, may be tried to damage the nerve and stop it sending pain messages to the brain.
Invasive surgery, MVD, involves opening the skull, moving offending blood vessels away and either removing them or inserting a sponge to act as a buffer.
Living with trigeminal neuralgia
Trigeminal neuralgia is not fatal, but it can be debilitating because pain can be triggered by everyday activities like contact with the cheek when shaving, washing the face, brushing teeth, eating, drinking or talking. To avoid pain, Dr Alyacoub advises using a soft toothbrush and avoiding hot and cold foods or drinks, and chewy foods.
Damage to the myelin sheath around the nerves can be a cause of trigeminal neuralgia