TRIGEMINAL NEURALGIA

Trigeminal neuralgia is a sudden, severe facial pain, described as sharp, shooting or like an electric shock.

It usually occurs in sudden short attacks lasting from a few seconds to about two minutes, which stop just as abruptly.

In the vast majority of cases it affects part or all of one side of the face, with the pain most commonly felt in the lower part of the face. Very occasionally it affects both sides of the face, but not normally at the same time.

People with the condition may experience attacks of pain regularly for days, weeks or months at a time. In severe cases, attacks may occur hundreds of times a day.

It’s possible for the pain to improve or even disappear altogether for several months or years at a time (known as a period of remission), although these periods of remission tend to get shorter with time. Some people may then go on to develop a more continuous aching, throbbing and burning sensation, sometimes accompanied by the sharp attacks.

Typically, the attacks of pain are brought on by activities that involve lightly touching the face, such as washing, eating and brushing the teeth, but they can also be triggered by wind (even a slight breeze or air conditioning) or movement of the face or head. Sometimes, the pain can occur without any trigger whatsoever.

Living with trigeminal neuralgia can be very difficult and it can have a significant impact on a person’s quality of life, resulting in problems such as weight loss, isolation and depression.

Symptoms of trigeminal neuralgia

The main symptom of trigeminal neuralgia is sudden attacks of severe, sharp and shooting facial pain that last from a few seconds to about two minutes.

The pain is often described as an excruciating sensation, similar to an electric shock. The attacks can be so severe that you are unable to do anything during them, and the pain can sometimes bring you to your knees.

Trigeminal neuralgia usually only affects one side of your face. In rare cases it can affect both sides, although not at the same time. The pain can be in the teeth, the lower jaw, upper jaw, cheek and, less commonly, in the forehead or the eye.

You may feel aware of an impending attack of pain, though these usually come unexpectedly.

After the main, severe pain has subsided, you may experience a slight ache or burning feeling. There may also be a constant throbbing, aching or burning sensation between attacks.

You may have episodes of pain lasting regularly for days, weeks or months at a time. It is possible for the pain to then disappear completely and not recur for several months or years (a period known as “remission”). However, in severe cases, attacks may occur hundreds of times a day, and there may be no periods of remission.

Symptom triggers

Attacks of trigeminal neuralgia can be triggered by certain actions or movements, such as:
•talking
•smiling
•chewing
•brushing your teeth
•washing your face
•a light touch
•shaving or putting on make-up
•swallowing
•kissing
•a cool breeze or air conditioning
•head movements
•vibrations, such as walking or a car journey

However, pain can occur spontaneously with no triggers whatsoever.

Further problems

Living with trigeminal neuralgia can be extremely difficult, and your quality of life can be significantly affected.

You may feel like avoiding activities such as washing, shaving or eating to avoid triggering pain, and the fear of pain may mean you avoid social activities. However, it’s important to try to live a normal life, and be aware that becoming undernourished or dehydrated can make the pain far worse.

The emotional strain of living with repeated episodes of pain can lead to psychological problems, such as depression. During periods of extreme pain, some people may even consider suicide. Even when pain-free, you may live in fear of the pain returning.

When to see your Acupuncturist

You should see your Acupuncturist if you experience frequent or persistent facial pain, particularly if standard painkillers such as paracetamol and ibuprofen do not help and a dentist has ruled out any dental causes.

Your Acupuncturist will try to identify the problem by asking about your symptoms and ruling out conditions that could be responsible for your pain. Trigeminal neuralgia can be a difficult condition to diagnose, so it’s important to try to describe your symptoms as accurately and in as much detail as possible.

Causes of trigeminal neuralgia

Although the exact cause is not known, trigeminal neuralgia is often thought to be caused by compression of the trigeminal nerve or an underlying condition affecting this nerve.

The trigeminal nerve

The trigeminal nerve (also called the fifth cranial nerve) is the largest nerve inside the skull. You have two trigeminal nerves, one in each side of your face. Small branches from different parts of the face join into three major nerve branches. These are:

  • the upper branch (ophthalmic) – which carries sensory information from the skinabove the eye, forehead and front of the head
    •the middle branch (maxillary) – which carries sensory information from the skin through the cheek, side of the nose, upper jaw, teeth and gums
    •the lower branch (mandibular) – which carries sensory information from the skin through the lower jaw, teeth and gums

These branches enter the skull through three different routes and then join together in what is called the Gasserian ganglion, before connecting to the brainstem in the part of the skull called the posterior fossa.

Trigeminal neuralgia can involve one or more branches of the trigeminal nerve. The maxillary and mandibular branches are affected most often, and the ophthalmic branch is the least commonly affected.

Pressure on the trigeminal nerve

Evidence suggests that in up to 95% of cases, the cause of trigeminal neuralgia is pressure on the trigeminal nerve close to where it enters the brain stem (the lowest part of the brain that merges with the spinal cord), past the Gasserian ganglion.

In most cases, this pressure seems to be caused by an artery or vein compressing the trigeminal nerve, although it’s not known why this happens.

It’s also not clear exactly why this pressure can cause painful attacks, as not everyone with a compressed trigeminal nerve will experience pain. It may be that, in some people, the pressure on the nerve wears away its protective outer layer called the myelin sheath, which may cause uncontrollable pain signals to travel along the nerve.

However, this does not fully explain why periods of remission (periods without symptoms) can occur and why pain relief is immediate after a successful operation to move the blood vessels away from the nerve.

Other underlying causes

Other reasons why the trigeminal nerve can become compressed or damaged include:
•a tumour (a growth or lump)
•a cyst (fluid-filled sac)
•arteriovenous malformation (an abnormal tangle of arteries and veins)
•multiple sclerosis (MS) – a long-term condition that affects the central nervous system (the brain and spinal cord)

Diagnosing trigeminal neuralgia

As the pain caused by trigeminal neuralgia is often felt in the jaw, teeth or gums, it is common for people to visit their dentist initially, rather than their Acupuncturist.

If you visit your dentist, they will ask you questions about your symptoms and investigate your facial pain using a dental X-ray and other means to look for other more common causes, such as a dental infection or cracked tooth.

If the dentist cannot find a cause, it is important not to undergo unnecessary treatment such as a root canal filling or an extraction, even though you may be convinced that it is a tooth problem. If your dentist cant find anything wrong, do not try to persuade them to remove a particular tooth, as this will not solve the problem.

Often, the diagnosis of trigeminal neuralgia is made by a dentist, but if you have already seen your dentist and they have not been able to find an obvious cause of your pain, visit your Acupuncturist.

Seeing your Acupuncturist

There is no specific test for trigeminal neuralgia, so a diagnosis is largely based on your symptoms and your description of the pain.

If you have experienced facial pain, your Acupuncturist will ask you questions about your symptoms, such as how often they occur, how long the pain attacks last and which areas of your face are affected. The more details about your pain you can provide, the better.

Your Acupuncturist will consider other possible causes of your pain and may also examine your head and jaw to identify which parts are painful.

Ruling out other conditions

An important part of the process of diagnosing trigeminal neuralgia involves ruling out other conditions that can also cause facial pain.

By asking about your symptoms and carrying out an examination, your Acupuncturist may be able to rule out other conditions, such as:
•migraine
•joint pain in the lower jaw
•giant cell arteritis (temporal arteritis) – a condition in which medium and large arteries in the head and neck become inflamed and cause pain in the jaw and temples
•a possible injury to one of the facial nerves

Your medical, personal and family history will also need to be taken into consideration when determining possible causes of your pain.

For example, trigeminal neuralgia is less likely if you are under 40 years old, and multiple sclerosis (MS) may be more likely if you have a family history of the condition or if you have some other form of this condition. However, trigeminal neuralgia is very unlikely to be the first symptom of MS.

Treating trigeminal neuralgia

There are a number of treatments available that can offer some relief from the pain caused by trigeminal neuralgia.

Identifying triggers and avoiding them can also help.

Most people with trigeminal neuralgia will be prescribed medication to help control their pain, although surgery may be considered for the longer term in those cases where medication is ineffective or causes too many side effects.

Avoid triggers

The painful attacks associated with trigeminal neuralgia can sometimes be triggered or made worse by a number of different things. Therefore, in addition to your medical treatment, it may help to try to avoid these triggers, if possible.

For example, if your pain is triggered by wind or even a draught in a room, it may help to avoid sitting near open windows or the source of air conditioning, and wearing a scarf wrapped around your face in windy weather. A transparent dome-shaped umbrella can also protect your face from the weather.

Hot, spicy or cold food or drink may also trigger your pain, so avoiding these can help. Using a straw to drink warm or cold drinks may also help prevent the liquid coming into contact with the painful areas of your mouth. It is important to eat nourishing meals, however, so if you are having difficulty chewing, consider eating mushy foods or liquidising your meals.

Certain foods seem to trigger attacks in some people, so you may want to consider avoiding things such as caffeine, citrus fruits and bananas.

However, this is largely only because trigeminal neuralgia is a rare condition, and clinical trials are difficult to carry out on such a painful condition because giving some people an inactive, “dummy” medication (placebo) to compare these medications to would be unethical and impractical.

However, many specialists will prescribe an unlicensed medication if they think it is likely to be effective and the benefits of treatment outweigh any associated risks, But Acupuncture can Relieve symptoms and cure trigeminal neuralgia within a short period of time.

If your specialist is considering prescribing an unlicensed medication to treat trigeminal neuralgia, they should inform you that it is unlicensed and discuss possible risks and benefits with you.

With most of these medications, the side effects can be quite difficult to cope with initially. Not everyone experiences side effects, but if you do, try to persevere because they do tend to diminish with time or at least until the next dosage increase, when you may find a further period of adjustment is necessary. Talk to your Acupuncturist if you are finding the side effects unbearable.

 

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