Doctor's Notes on Trigeminal Neuralgia (Facial Nerve Pain)
Trigeminal neuralgia is a condition that causes facial pain. The symptoms and signs of trigeminal neuralgia are intermittent pain that, when present, is described as bursts of sharp, stabbing electric-shock like pain, usually on one side of the face; facial muscle spasms (termed tic douloureux) can accompany the pain. Pain can last from a few seconds to a few minutes. Many patients feel symptoms of irritability, anxiety and depression – some even become suicidal because they live in fear of unpredictable bursts of facial pain. Few people, however, experience a dull ache between attacks.
The syndrome of trigeminal neuralgia has no clear-cut cause. Some experts argue that it is caused by traumatic damage (compression) to the trigeminal nerve as it passes through openings in the skull to reach the muscles and tissues of the face; others believe the cause stems from a biochemical change in the nerve. Many common activities can trigger a trigeminal neuralgia attack (for example, a light touch or vibration on the face, washing your face or even having the wind blow against the face). Eating and chewing can also trigger an attack; many people with the disease experience weight loss, dehydration and/or malnutrition because they fear triggering an attack.
Trigeminal Neuralgia (Facial Nerve Pain) Symptoms
- A defining feature of trigeminal neuralgia is the trigger zone-a small area in the central part of the face, usually on a cheek, nose, or lip, that, when stimulated, triggers a typical burst of pain.
- A light touch or vibration is the most effective trigger.
- Because of this, many common daily activities trigger the attacks.
- Washing your face, brushing your teeth, shaving, or talking
- Common sensations such as having wind hit your face
- Eating and chewing
- Many people avoid food and drink rather than experience the severe pain.
- Between attacks, most people remain relatively pain-free. A subgroup, however, experience a dull ache between attacks, suggesting physical compression of the affected nerve, either by a blood vessel or some other structure.
Trigeminal Neuralgia (Facial Nerve Pain) Causes
- The condition has no clear-cut cause.
- Some experts argue that the syndrome is caused by traumatic damage to the nerve as it passes from the openings in the skull to the muscles and tissue of the face. The damage compresses the nerve, causing the nerve cell to shed the protective and conductive coating (demyelination).
- Others believe the cause stems from biochemical change in the nerve tissue itself.
- A more recent notion is that an abnormal blood vessel compresses the nerve as it exits from the brain itself.
- In all cases, though, an excessive burst of nervous activity from a damaged nerve causes the painful attacks.
The perception of pain varies with each individual; terms such as stabbing, prickling, burning, tingling, and other descriptions have been used. Nerve pain is difficult to live with but in most individuals, it can be reduced. Nerve pain is also called neuropathic pain.
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.