Orofacial or Trigeminal Pain

Orofacial or Trigeminal Pain

Trigeminal neuralgia is a chronic pain condition that affects the trigeminal nerve, which carries sensation from your face to your brain. If you have trigeminal neuralgia, even mild stimulation of your face such as from brushing your teeth or putting on makeup may trigger a jolt of excruciating pain.

You may initially experience short, mild attacks. But trigeminal neuralgia can progress and cause longer, more-frequent bouts of searing pain. Trigeminal neuralgia affects women more often than men, and it’s more likely to occur in people who are older than 50. Because of the variety of treatment options available, having trigeminal neuralgia doesn’t necessarily mean you’re doomed to a life of pain. Doctors usually can effectively manage trigeminal neuralgia with medications, injections, or surgery.

Symptoms

Branches of the trigeminal nerve

Trigeminal neuralgia symptoms may include one or more of these patterns:

• Episodes Of Severe, Shooting Or Jabbing Pain That May Feel Like An Electric Shock
• Spontaneous Attacks Of Pain Or Attacks Triggered By Things Such As Touching The Face, Chewing, Speaking Or Brushing Teeth
• Bouts Of Pain Lasting From A Few Seconds To Several Minutes
• Episodes Of Several Attacks Lasting Days, Weeks, Months, Or Longer — Some People Have Periods When They Experience No Pain
• Constant Aching, Burning Feeling That May Occur Before It Evolves Into The Spasm-Like Pain Of Trigeminal Neuralgia
• Pain In Areas Supplied By The Trigeminal Nerve, Including The Cheek, Jaw, Teeth, Gums, Lips, Or Less Often The Eye And Forehead
• Pain Affecting One Side Of The Face At A Time, Though May Rarely Affect Both Sides Of The Face
• Pain Focused In One Spot Or Spread In A Wider Pattern
• Attacks That Become More Frequent And Intense Over Time

Diagnosis

Your doctor will diagnose trigeminal neuralgia mainly based on your description of the pain, including:

• Type: Pain Related To Trigeminal Neuralgia Is Sudden, Shock-Like, And Brief.
• Location: The Parts Of Your Face That Are Affected By Pain Will Tell Your Doctor If The Trigeminal Nerve Is Involved.
• Triggers: Trigeminal Neuralgia-Related Pain Usually Is Brought On By Light Stimulation Of Your Cheeks, Such As From Eating, Talking, Or Even Encountering A Cool Breeze.

Your doctor may conduct many tests to diagnose trigeminal neuralgia and determine underlying causes for your condition, including:

• A neurological examination: Touching and examining parts of your face can help your doctor determine exactly where the pain is occurring and — if you appear to have trigeminal neuralgia — which branches of the trigeminal nerve may be affected. Reflex tests also can help your doctor determine if your symptoms are caused by a compressed nerve or another condition.
• Magnetic resonance imaging (MRI): Your doctor may order an MRI scan of your head to determine if multiple sclerosis or a tumor is causing trigeminal neuralgia. In some cases, your doctor may inject a dye into a blood vessel to view the arteries and veins and highlight blood flow (magnetic resonance angiogram).

Your facial pain may be caused by many different conditions, so an accurate diagnosis is important. Your doctor may order additional tests to rule out other conditions.

Treatment

Trigeminal neuralgia treatment usually starts with medications, and some people don’t need any additional treatment. However, over time, some people with the condition may stop responding to medications, or they may experience unpleasant side effects. For those people, injections or surgery provide other trigeminal neuralgia treatment options.

Medications

To treat trigeminal neuralgia, your doctor usually will prescribe medications to lessen or block the pain signals sent to your brain.

Anticonvulsants: Doctors Usually Prescribe Carbamazepine For Trigeminal Neuralgia, And It’s Been Shown To Be Effective In Treating The Condition. Other Anticonvulsant Drugs That May Be Used To Treat Trigeminal Neuralgia Include Oxcarbazepine, Lamotrigine And Phenytoin. Other Drugs, Including Clonazepam And Gabapentin, Also May Be Used.

If The Anticonvulsant You’re Using Begins To Lose Effectiveness, Your Doctor May Increase The Dose Or Switch To Another Type. Side Effects Of Anticonvulsants May Include Dizziness, Confusion, Drowsiness, And Nausea. Also, Carbamazepine Can Trigger A Serious Drug Reaction In Some People, Mainly Those Of Asian Descent, So Genetic Testing May Be Recommended Before You Start Carbamazepine.

Antispasmodic Agents: Muscle-Relaxing Agents Such As Baclofen May Be Used Alone Or In Combination With Carbamazepine. Side Effects May Include Confusion, Nausea, And Drowsiness.

Botox Injections: Small Studies Have Shown That botulinum toxin A (Botox) Injections May Reduce Pain From Trigeminal Neuralgia In People Who Are No Longer Helped By Medications. However, More Research Needs To Be Done Before This Treatment Is Widely Used For This Condition.

Other Procedures May Be Used To Treating Trigeminal Neuralgia, Such As A Rhizotomy. In A Rhizotomy, Nerve Fibers Are Destroyed To Reduce Pain, And This Causes Some Facial Numbness.

Types Of Rhizotomy Include:

• Glycerol Injection: During This Procedure, Your Doctor Inserts A Needle Through Your Face And Into An Opening In The Base Of Your Skull. Your Doctor Guides The Needle Into The Trigeminal Cistern, A Small Sac Of Spinal Fluid That Surrounds The Trigeminal Nerve Ganglion — Where The Trigeminal Nerve Divides Into Three Branches — And Part Of Its Root. Then, Your Doctor Will Inject A Small Amount Of Sterile Glycerol, Which Damages The Trigeminal Nerve And Blocks Pain Signals. This Procedure Often Relieves Pain. However, Some People Have A Later Recurrence Of Pain, And Many Experience Facial Numbness Or Tingling.
• Balloon Compression: In Balloon Compression, Your Doctor Inserts A Hollow Needle Through Your Face And Guides It To A Part Of Your Trigeminal Nerve That Goes Through The Base Of Your Skull. Then, Your Doctor Threads A Thin, Flexible Tube (Catheter) With A Balloon On The End Through The Needle. Your Doctor Inflates The Balloon With Enough Pressure To Damage The Trigeminal Nerve And Block Pain Signals.
• Balloon Compression Successfully Controls Pain In Most People, At Least For A Period Of Time. Most People Undergoing This Procedure Experience At Least Some Transient Facial Numbness.
• Radiofrequency Thermal Lesioning: This Procedure Selectively Destroys Nerve Fibers Associated With Pain. While You’re Sedated, Your Surgeon Inserts A Hollow Needle Through Your Face And Guides It To A Part Of The Trigeminal Nerve That Goes Through An Opening At The Base Of Your Skull.
• Once The Needle Is Positioned, Your Surgeon Will Briefly Wake You From Sedation. Your Surgeon Inserts An Electrode Through The Needle And Sends A Mild Electrical Current Through The Tip Of The Electrode. You’ll Be Asked To Indicate When And Where You Feel Tingling.
• When Your Neurosurgeon Locates The Part Of The Nerve Involved In Your Pain, You’re Returned To Sedation. Then The Electrode Is Heated Until It Damages The Nerve Fibers, Creating An Area Of Injury (Lesion). Radiofrequency Thermal Lesioning Usually Results In Some Temporary Facial Numbness After The Procedure. Pain May Return After Three To Four Years.

Surgery

• Surgical options for trigeminal neuralgia include:
• Microvascular Decompression.
• Brain Stereotactic Radiosurgery (Gamma Knife).

• Category: Conditions We Treat