Condition: Trigeminal neuralgia (TN) is a chronic pain condition that affects the nerve that delivers sensation from your face to your brain.
Background: Patients typically experience pain either spontaneously or following mild stimulation, such as washing the face, shaving, brushing teeth, or chewing.
Risk Factors: TN sometimes occurs in concert with multiple sclerosis and is more often diagnosed in those over the age of 40.
History and Symptoms: Pain is typically only on one side of the face, although sometimes patients experience pain on both sides of the face during different episodes. Patients report a sudden stabbing pain that lasts for seconds to a few minutes with no pain between episodes. Pain is provoked by mild stimuli to the face (gentle touching, washing, eating, etc.). Other stimuli such as bright lights, loud noises, or tastes can occasionally provoke this pain. Pain may prevent or limit eating or drinking.
Physical Exam: Because TN is a clinical disease, a physical examination is likely to be normal, but examination of the head and neck, including the mouth, teeth, and jaw joint, and a neurological examination are useful in order to rule out other conditions. Typical trigger areas, which are commonly around the mouth, should be examined. Physical medicine and rehabilitation (PM&R) physicians are trained to perform these types of detailed neurological and musculoskeletal examinations, which is critical to accurately diagnose TN.
Diagnostic Process: MRI may be useful to identify tumors, multiple sclerosis plaques, or blood vessel contact with the affected nerve, as this contact is the underlying cause of pain in the majority of cases. Examination of the reflexes in this region is the most reliable diagnostic test for this pain.
Rehab Management: Pain from TN can usually be managed with medications, such as anti-seizure medications, certain types of antidepressants, and, for severe cases, opioids. Acupuncture, relaxation, and meditation may also be beneficial in conjunction with medications. Pain procedures, such as nerve blocks, may be very effective for TN. Surgery to alleviate the vessel compression of the affected nerve can be performed in cases that are not controlled by other therapies. PM&R physicians are skilled at managing TN with all of the above listed options (with the exception of surgery, which would require a Neurosurgeon).
Other Resources for Patients and Families: Resources for patient support are available at the TNA Facial Pain Association website. If pain is limiting eating and drinking, a nutritional consultation may be necessary.