What is Trigeminal Neuralgia? What Are Its Symptoms? How Is It Diagnosed and Treated?

Have you experienced a sudden and severe electric shock-like sensation in your face? Trigeminal neuralgia is a neurological condition that causes excruciating facial pain and can seriously affect your daily life. Usually occurring on only one side of the face, this pain manifests itself as an electric shock, stabbing, or burning sensation.

While these pain attacks can last for a few seconds, they can also extend up to a few minutes. In addition, even mild stimuli in the facial region can cause excruciating pain to be triggered. Therefore, trigeminal neuralgia is known as a condition that can disrupt your sleep pattern and significantly reduce your quality of life.

Mostly occurring in advanced ages, trigeminal neuralgia is a condition that starts suddenly with triggers and prevents you from performing your daily activities. In this article, we will discuss in detail what trigeminal neuralgia is, its symptoms, diagnostic methods, and the treatment options available to you.

What is Trigeminal Neuralgia?

The trigeminal nerve is the largest cranial nerve located in your facial region and extending to the brain. This important nerve forms a critical part of your body's nervous system, and trigeminal neuralgia is a painful condition that occurs as a result of this nerve being affected.

Functions of the trigeminal nerve

The trigeminal nerve (fifth cranial nerve) is the largest and thickest of the cranial nerve pairs. Its name comes from "trigeminus" meaning "triplet" because it divides into three main branches: n. ophthalmicus (eye region), n. maxillaris (upper jaw), and n. mandibularis (lower jaw).

This nerve allows you to perceive and transmit sensations in your face. It also helps you control movements such as chewing and biting. Thanks to this nerve extending from your forehead to your chin, you can perceive touch, pain, and temperature sensations on your face.

The first branch (ophthalmic) provides sensory transmission to the forehead skin, cornea, and around the eyes, the second branch (maxillary) to the middle part of the face, and the third branch (mandibular) to the lower jaw region. In addition, the third branch also sends motor nerve fibers to your masticatory muscles, controlling your chewing movements.

What does trigeminal neuralgia mean?

Trigeminal neuralgia is a chronic pain disorder that occurs when the trigeminal nerve, which carries sensations from your face to the brain, is affected. Also known in the medical world as "tic douloureux", this disease manifests itself with suddenly starting, electric shock-like or stabbing pain attacks.

In this disease, pain is usually seen on one side of the face and is frequently felt in the distribution areas of the second (maxillary) or third (mandibular) divisions of the nerve. Interestingly, the right side of the face is affected more frequently than the left side.

The diagnosis of the disease is based on three main criteria: the pain being limited to one or more divisions of the trigeminal nerve; sudden, intense, and very short-lived pain attacks; and pain triggered by mild stimuli that do not normally cause pain. With a worldwide incidence of 5 in 100,000, this disease is seen about 2 times more frequently in women than in men.

Why it is referred to as the disease that drives people to madness

Trigeminal neuralgia is known in society as the "disease that drives you mad" or "suicide disease". The reason for this is the excruciating pain created by the disease and the unpredictability of this pain.

Even simple daily activities such as brushing teeth or gently touching the facial region can trigger severe pain attacks for patients. This condition prevents patients from their normal life routines and seriously lowers their quality of life.

The intensity of the pain is so high that patients generally describe the agony they experience as "the greatest pain I have ever experienced in my life." The fact that pain attacks are unpredictable and appear suddenly also causes patients to live in constant anxiety.

Therefore, trigeminal neuralgia poses a great burden not only physically but also psychologically. Poor quality of life and, in severe cases, even suicidal ideation have been attributed to this disease in some patients. For these reasons, the name "disease that drives you mad" reflects the feeling of helplessness created by this disorder quite well.

What Are the Symptoms of Trigeminal Neuralgia?

Known as one of the most severe nerve pains, trigeminal neuralgia manifests itself with symptoms that can turn your life upside down. Most patients describe this experience as "the greatest pain of my life." This pain is usually seen on only one side of the face and is rarely felt on both sides.

Type of pain: electric shock, stabbing

Trigeminal neuralgia pain is quite characteristic. Patients generally describe this pain as an "electric shock" or "stabbing." The pain appears suddenly and severely. You may also feel tingling, burning, aching, and facial spasms in your face.

These sharp pains are mostly seen in the jaw, nose, and cheek. However, in some cases, the pain can encompass the entire face. Pain often starts in the lower jaw and the part of the cheek close to the lip. Therefore, many patients initially think this is a toothache.

Duration and frequency of pain

Trigeminal neuralgia attacks usually last between a few seconds and a few minutes. These pain attacks can occur when there are no stimuli at all, or they can appear with triggering factors.

The frequency of pain varies greatly from person to person. In some patients, pain attacks recur every 10 minutes, while in others there may be pain-free periods lasting for days. The patient may be exposed to this pain attack even 20-30 times a day.

Interestingly, trigeminal neuralgia patients sometimes experience pain-free periods lasting months or years. However, as the disease progresses, the intervals between attacks shorten and the intensity of the pain increases.

Triggering factors: touching, eating, wind

There are many factors that trigger trigeminal neuralgia pain. Among these are:

Touching the face or being lightly touched

Chewing, speaking, or swallowing

Brushing teeth or rinsing the mouth

Shaving or applying makeup

Cold weather or blowing wind

Washing the facial region

Smiling or grimacing

Due to these triggers, patients may avoid eating, speaking, and even facial cleansing over time. This condition can cause patients to lose weight and experience a decline in quality of life.

Facial numbness, tingling, and muscle spasms

Alongside severe pain, a feeling of numbness or tingling in the facial region can also be observed in trigeminal neuralgia patients. In some cases, spasms or twitching in the facial muscles may occur.

In severe pains, spasms occur in the facial muscles; this finding is the reason why the old name of the disease is known as "tic douloureux." These contractions manifest themselves at the most intense moments of the pain.

Additionally, before the onset of an episode, you may experience warning signs such as numbness or chronic pain in the trigeminal nerve region. By paying attention to these symptoms, you can be prepared for a potential attack.

However, some patients may have a dull, continuous jaw pain that occurs before trigeminal neuralgia, called "pretrigeminal neuralgia." This condition can be a harbinger of an approaching trigeminal neuralgia period.

What Causes Trigeminal Neuralgia?

There can be many different factors triggering the pain in your trigeminal nerve. Today, medical science has largely determined the main causes underlying this disorder. Pressure, damage, or inflammation on the nerve can lead to this extremely painful condition.

Vascular compression

In the vast majority of trigeminal neuralgia cases (85-90%), the main cause is a blood vessel putting pressure on the trigeminal nerve. This condition is medically called "vascular compression." An artery or vein located in the brainstem or inside the skull puts pressure on the trigeminal nerve and erodes the protective sheath of the nerve over time.

As a result of this pressure, the nerve begins to send unusual and faulty signals. Especially as you age, your blood vessels harden and the pressure on the nerve increases further. Consequently, you experience sudden and severe pain attacks on one side of your face.

Multiple sclerosis and nerve sheath damage

The risk of developing trigeminal neuralgia among Multiple Sclerosis (MS) patients is quite high. Studies show that this disorder develops in approximately 2-5% of MS patients. In fact, compared to individuals without MS, MS patients have a 15-20 times higher risk of developing trigeminal neuralgia.

In MS disease, the myelin sheath protecting the nerve fibers is damaged. This damage can prevent the trigeminal nerve from functioning properly and cause pain attacks. Especially in trigeminal neuralgia caused by MS, the pain can be seen on both sides of the face, and this condition is a distinguishing feature for MS.

Tumors, trauma, and infections

Benign or malignant tumors putting pressure on the trigeminal nerve can also lead to pain attacks. Tumors such as acoustic neuroma, meningioma, and epidermoid cyst can create pressure in the region where the nerve enters the brainstem.

Nerve damage can also develop as a result of impacts to the facial region, tooth extractions, or surgical interventions in the facial region. In fact, in some cases, severe dental infections or viral infections such as shingles (herpes zoster) can also affect the trigeminal nerve and cause neuralgia pains.

Age, genetics, and lifestyle factors

Trigeminal neuralgia is usually seen in people over the age of 50 and is 2 times more common in women than in men. In individuals with a family history of this disorder, the risk of occurrence is 3-4 times higher compared to the normal population, which indicates that genetic factors play an important role.

Apart from these, lifestyle factors such as smoking and high blood pressure are also risk factors. However, in approximately 10% of cases, no cause can be determined, and this condition is called "idiopathic trigeminal neuralgia."

Regardless of the cause, trigeminal neuralgia pains can seriously affect your life. Therefore, it is of great importance to consult a neurology or neurosurgery specialist when you notice symptoms.

How is Trigeminal Neuralgia Diagnosed?

The diagnosis of trigeminal neuralgia is of critical importance for the initiation of correct treatment. Many patients may struggle with misdiagnoses for years and receive unnecessary treatments. First, it is important to understand how this disease is diagnosed correctly.

Clinical examination and patient history

The diagnosis of trigeminal neuralgia is largely based on clinical observation and patient history. In fact, specialists can diagnose this disorder simply by listening to the patient's history. Diagnosis is generally dependent on three main criteria: pain being limited to one or more branches of the trigeminal nerve; experiencing sudden, intense, and short-lived pain attacks; and pain triggered by stimuli that would not normally cause pain.

The doctor may observe you sitting and completely still during the examination. During this time, they may detect a blink or a small mouth movement that you do not notice during a spontaneously developing trigeminal neuralgia seizure.

Especially triggered paroxysmal (sudden) pain is specific to trigeminal neuralgia and is seen in 91-99% of patients. This condition can be considered the most defining feature of the disease.

Detection of nerve compression with MRI imaging

After the diagnosis is made, Magnetic Resonance (MRI) imaging is usually performed. The MRI scan is particularly used to detect the blood vessel, tumor, or multiple sclerosis plaques compressing the trigeminal nerve.

Especially CISS sequence MRI can image the trigeminal nerve emerging from the brainstem and heading towards the face and the blood vessels around it more clearly. In addition, the presence of a mass in the cerebellopontine region can also be detected with gadolinium-enhanced MRI series.

However, the point to be noted is that in the majority of trigeminal neuralgias, there may not be any tumor or vascular anomaly. Therefore, a normal MRI result does not rule out the diagnosis.

Differential diagnosis: migraine, toothache, sinusitis

There are many diseases that can be confused with trigeminal neuralgia. The biggest problem is that patients apply to dentists by being confused with a toothache. In this case, unnecessary tooth extractions can be performed if proper guidance is not provided.

Other diseases showing similar clinical symptoms are:

Atypical facial pain (gives more of a burning sensation and is not limited to the trigeminal nerve distribution)

Migraine and cluster headache

Sinusitis

Jaw joint disorders

Postherpetic neuralgia

Glossopharyngeal neuralgia

Many diseases such as migraine, tension headache, and jaw joint disorders can cause unilateral facial pain. Therefore, being examined by a specialist doctor is of great importance.

Trigeminal Neuralgia Treatment Methods

The main goal in the treatment of trigeminal neuralgia is to bring excruciating pains under control and ensure you return to normal life. Different treatment options are available today, and your doctor will determine the most appropriate method for you.

Drug therapy: anticonvulsants, antidepressants

The first step in the treatment of trigeminal neuralgia is usually drug therapy. Epilepsy medications such as carbamazepine (Tegretol) are preferred first. These medications relieve pain in the majority of patients. If your pain decreases after starting to use Tegretol, this confirms the diagnosis of trigeminal neuralgia.

Anticonvulsant medications alleviate pain by bringing abnormal electrical signals in the nerve under control. In addition to this, neuropathic pain medications such as gabapentin and antidepressants can also be added to the treatment plan.

However, over time, the effect of these medications may decrease or side effects may be seen. You may experience side effects such as drowsiness, weakness, and a decrease in white blood cells. Therefore, regular doctor control is required in long-term use.

Surgical methods: microvascular decompression, balloon compression

When a response to drug therapy cannot be obtained, surgical treatment options come into play. Microvascular decompression (MVD) is the preferred method especially in young patients and in situations where vascular compression of the nerve has been demonstrated. In this operation, the blood vessel putting pressure on the trigeminal nerve is moved away from the nerve with a special material. As a result, a life free of pain is possible for the vast majority of patients for a lifetime. The success rate of MVD is as high as 90%.

Another surgical option is balloon compression via foramen ovale puncture. In this procedure, the trigeminal nerve ganglion is reached by entering through the cheek, and the nerve is compressed with a balloon. This method can be applied in a shorter time and its surgical risks are lower, but the pain-free period may be shorter.

Alternative methods: acupuncture, biofeedback

According to the World Health Organization, acupuncture is one of the methods that can be effective in the treatment of trigeminal neuralgia. Both needle and laser acupuncture applications can be performed. In some patients, close to 100% recovery in the face can be achieved in a short time.

Especially in the early stage of the disease and in patients with low drug use, the success rate of acupuncture is higher. The success rate in the treatment applied for an average of 15-20 sessions is approximately 80%.

Response to treatment and quality of life

If trigeminal neuralgia is not treated, the duration and frequency of pain attacks can increase over time. This condition seriously affects your quality of life, making it difficult to perform daily activities.

Pain control can be achieved in the vast majority of patients with correct treatment. Surgical intervention is recommended in situations that cannot be brought under control with drug therapy. The recurrence probability after MVD operation is around 4% annually.

When an appropriate treatment method is chosen and early intervention is made, the likelihood of patients returning to normal life is quite high. Therefore, it is of great importance to consult a specialist without wasting time when you notice symptoms.

Frequently Asked Questions

Many questions may arise in your mind in the face of the difficulties you experience regarding trigeminal neuralgia. Here are the answers to the most frequently asked questions:

Which department looks at trigeminal neuralgia?

You should primarily consult Neurology or Brain and Neurosurgery specialists for your trigeminal neuralgia complaints. These specialists can diagnose the disease and create an appropriate treatment plan. Many patients may first apply to dentists, especially with complaints similar to toothache, but the evaluation of a neurology specialist is important for a correct diagnosis.

Does trigeminal neuralgia go away on its own?

Sometimes pains can go away on their own, and pain-free periods lasting months or even years can be experienced. However, in most cases, it needs to be treated. In untreated trigeminal neuralgia, the duration and frequency of pain attacks may increase over time.

What is good for neuralgia pain?

The first step of treatment is medications. Epilepsy medications, particularly carbamazepine (Tegretol), are effective in the treatment of trigeminal neuralgia. The reduction of pain after the patient starts using Tegretol is a sign confirming the diagnosis.

Is trigeminal neuralgia surgery risky?

As with any surgical procedure, trigeminal neuralgia surgeries also carry risks. Complications such as deafness, infection, and blood clot formation at the surgical site can develop in microvascular decompression surgery. Additionally, though very rare, there is a risk of stroke and death. However, these risks can be minimized with the experience and care of the surgeon.

Does trigeminal neuralgia cause headaches?

Yes, trigeminal neuralgia can cause headaches and is therefore sometimes confused with migraine or cluster type headaches. It is possible to distinguish these diseases from each other with a good examination and doctor's experience.

Does trigeminal neuralgia get confused with toothache?

Definitely. Trigeminal neuralgia is most frequently confused with toothache. Unfortunately, many patients undergo unnecessary dental treatments until a correct diagnosis is made, and some even have healthy teeth extracted. The fact that the pain is in the form of an electric shock and is short-lived is important in distinguishing it from toothache.

What is good for trigeminal neuralgia?

In addition to drug therapy, complementary treatment methods such as acupuncture and neural therapy can also alleviate pain. Furthermore, avoiding triggering factors, protecting the facial region from the cold, and stress management also help reduce pain attacks.

When is trigeminal neuralgia dangerous?

You need to seek urgent medical help in case of an increase in the frequency and intensity of pain, lack of response to over-the-counter painkillers, a continuous electric shock sensation on one side of the face, and pains occurring without a triggering factor. These symptoms may indicate that the disease is progressing.

Conclusion

In conclusion, trigeminal neuralgia is a disorder that can seriously affect your daily life and causes sharp and sudden pains in the face. These electric shock-like pains, especially occurring on one side of the face, can make even your simple daily activities impossible.

The diagnosis of the disease is generally based on patient history and supported by MRI imaging. However, remember that your symptoms may be confused with other disorders such as toothache, sinusitis, or migraine. Therefore, it is of great importance to apply to a neurology or neurosurgery specialist with your complaints.

During the treatment process, drug therapy is tried first. When your pains cannot be brought under control with medications, surgical interventions may come to the agenda. Surgeries such as microvascular decompression can offer a permanent solution.

Additionally, alternative treatment methods like acupuncture also yield positive results in some patients. Lifestyle changes such as avoiding triggering factors and stress management can also reduce pain attacks.

Although trigeminal neuralgia is referred to as the "disease that drives you mad," you can regain your quality of life with early diagnosis and appropriate treatment. When the frequency and intensity of your pains increase, consulting your doctor without wasting time is quite important for the success of the treatment process.

Being equipped with accurate information and cooperating with healthcare professionals in this challenging process will provide you with great support in your trigeminal neuralgia treatment.

Trigeminal neuralgia is a disorder characterized by sudden and severe pain in the face, reducing the quality of life. Discover the symptoms, diagnostic methods, and treatment options in this article.