Trigeminal neuralgia
What is trigeminal neuralgia?
Trigeminal neuralgia is a type of facial pain. It is caused by a problem with the trigeminal nerve, which is a nerve that is responsible for sensation in the face.
- The pain is typically described as sharp, brief, electrical.
- The pain is usually in the cheek, mouth, gum or teeth area. More rarely it can be in the eye or forehead, but in this case your doctor will think about other causes.
- The pain can be triggered by touching, even lightly, certain parts of the face or mouth (what is called trigger zones). Talking, chewing, shaving, anything that involves the face and mouth can trigger. Cold wind, cold foods or beverages can also trigger.
- The pain can occur only with triggers, or spontaneously. There may be periods where the pain is very frequent, and periods of remission.
- Usually there is not pain between the shocks, but in some cases a constant pain can be felt
What causes trigeminal neuralgia?
Anything that compresses or irritates the trigeminal nerves can cause this type of pain. Some conditions that can cause trigeminal neuralgia include:
- Any tumor pushing on a nerve
- Multiple sclerosis, as the myelin that protects the nerve can be damaged
- A blood vessel running close to the nerve (vascular loop)
- Infections with varicella or herpes viruses can also cause neuralgias
- Anything else pushing on the nerve root or branches
I feel the pain in my tooth. Can the dentist just remove it?
That’s a very important thing to discuss. The pain of trigeminal neuralgia may be felt in the gum or tooth, but it does NOT come from a problem in the tooth. It comes from a problem upstream, in the portion of the nerve that is inside the skull. If the dentist says that your teeth are OK and do not require interventions, don’t get any. An intervention might actually fire things up and worsen your situation. Of course, if you have trigeminal neuralgia you may also get a true tooth problem, in which case that should be treated as it may deteriorate the pain.
Who is more at risk for trigeminal neuralgia?
It affects people mostly above the age of 50, although it can happen at younger ages and in children. Females are slightly more affected than males.
Any young person with trigeminal neuralgia should be investigated for multiple sclerosis or another cause.
How can my doctor diagnose trigeminal neuralgia?
There is no specific test that can diagnose this condition. It is a clinical diagnosis, meaning, your doctor will diagnose this based on your description of the attacks along with a neurological examination. Usually, an MRI of the brain will be done to look for compression on the nerve, but very often the test comes back normal.
What treatments could I use for trigeminal neuralgia?
Trigeminal neuralgia can be extremely disabling if the pain is not controlled. Medications used for this are targeting the nerves. They treat «neuropathic pain» (a fancy term to say that the pain comes from irritated nerves). Some medications (most of them anti-seizure drugs) that can be used are:
- Gabapentin (Neurontin) and Pregabalin (Lyrica)
- Carbamazepine (Tegretol) and oxcarbazepine (Trileptal)
- Phenytoin (Dilantin)
- Baclofen
- Lamotrigine (Lamictal)
Usually the doctor will try to avoid opioids (morphine-type medications) for neuralgias, but in severe cases they may be used.
Can I get surgery or other procedures for this problem?
Yes. Surgery can be recommended, especially if the medications are not working. This is always a decision that should be made with discussion between the person suffering, the neurologist and the surgeon. Also, radiotherapy can be used for trigeminal neuralgia. Options include:
- Brain surgery (with an opening of the skull) to put a pad between the nerve and an artery close to it. This is called Neurovascular decompression.
- Radiotherapy (sending rays in a very focused way on the zone that relays pain in the brainstem)
- Block of the trigeminal nerve or ganglion
- Botox (injections in the face)
Your doctor can discuss these with you if they are required.
In summary, trigeminal neuralgia is a type of facial pain that can be very disabling. Seeing a neurologist is usually necessary to look over different causes and try different treatments.
To read more on trigeminal neuralgia and find support:
http://tnac.org/tnac/
Post#408
I am wondering who I can contact about treatment for Trigeminal Neuralgia or find out ways to live with it? I live in London Ontario and for months have been bounced from referral to referral and from dentist to dentist in this region with no help.
I have been sent from one dentist in London to specialist after specialist who each thought it was a root canal and all of whom had to conduct their own xrays, scans, and do a full oral assessment – each was very expensive and each revealed that I had no related problems with my teeth. When each dentist or specialist determined that it was not something identifiable I would be referred to yet another specialist who repeated the process.
One dentist put in new all new crowns and another put veneers on 3 teeth. One dentist in London wanted to give me 4 root canals as the solution. While wondering whether to do this I was sent by a specialist to a local Endodontics who after a 10 minute, $1300.00 3D scan of part of my mouth determined that my tooth pain was Neuralgia, but who said that I would have to go through a family doctor which I do not have to get a referral to a specialist “because that wasn’t their thing”. When I asked the Endodontics clinic how to resolve the problems I was told that that constant pain in my teeth and in my jaw “was not a root canal issue but likely the result of a bad cleft palate surgery as evidenced by the fact that I have 2 calcified tooth roots or that I had a brain tumor or MS but that I should go to my family doctor”.
Another specialist I was referred to ignored my comments and questions to show his students “what a mouth with a cleft palate looked like” and then went onto to lecture me that “it likely was not TN because that is hard to assess and verify. Instead it was more likely that I was just looking for attention or pain drugs which is what most people who claim to have this issue really want.” This is the type of commentary I have been experiencing in my region.
My teeth are constantly hurting and I have no idea where to go to or what to do.
As a child I had several brain tumors and a cleft palate and have not generally had tooth problems in my life. However in the past year things have gotten more and more painful and several of my teeth constantly throb or are sensitive to even touch with my tongue or a tooth brush. While at other times they don’t hurt at all because of this dentists and doctors in my area think I am making up the pain.
I would really appreciate any advice or assistance in even relieving this pain. No clinic and no doctor in my region seems to even know what I am referring to.
Hi Sean,
I had the same experience until I had a dentist refer to my a specialist where I later got a MRI which came back normal and then later was referred to a neurologist. I think asking your family doctor to refer you to a neurologist will be your best bet for you to receive the treatment you need.