Trigeminal Pain

Trigeminal neuralgia is a sudden, severe facial pain, described as sharp, shooting or like an electric shock.

It usually occurs in sudden short attacks lasting from a few seconds to about two minutes, which stop just as abruptly. In the vast majority of cases it affects part or all of one side of the face, with the pain most commonly felt in the lower part of the face. Very occasionally it affects both sides of the face, but not normally at the same time.

It’s possible for the pain to improve or even disappear altogether for several months or years at a time (known as a period of remission), although these periods of remission tend to get shorter with time. Some people may then go on to develop a more continuous aching, throbbing and burning sensation, sometimes accompanied by the sharp attacks.

Typically, the attacks of pain are brought on by activities that involve lightly touching the face, such as washing, eating and brushing the teeth, but they can also be triggered by wind (even a slight breeze or air conditioning) or movement of the face or head.

When to seek medical advice

You should see your pain physician if you experience frequent or persistent facial pain, particularly if standard painkillers such as paracetamol andibuprofen do not help and a dentist has ruled out any dental causes

What causes trigeminal neuralgia?

In the vast majority of cases, trigeminal neuralgia is caused by compression of the trigeminal nerve.

How trigeminal neuralgia is treated

Trigeminal neuralgia is usually a long-term condition, and the periods of remission often get shorter over time. However, most cases can be controlled to at least some degree with treatment.

There are a number of treatments available that can offer some relief from the pain caused by trigeminal neuralgia.

Identifying triggers and avoiding them can also help.

Most people with trigeminal neuralgia will be prescribed medication to help control their pain.

Percutaneous procedures

There are a number of procedures that can offer some relief from trigeminal neuralgia pain, at least temporarily, by inserting a needle or thin tube through the cheek and into the trigeminal nerve inside the skull. These are known can “percutaneous” (through the skin) procedures, and they are carried out using X-rays to guide the needle or tube into the correct place while you are heavily sedated with medication or under a general anaesthetic (where you are asleep).

Percutaneous procedures that can be carried out to treat people with trigeminal neuralgia include:

  • Glycerol injections – where a medication called glycerol in injected around the Gasserian ganglion (where the three main branches of the trigeminal nerve join together)
  • Radiofrequency lesioning – where a needle is used to apply heat directly to the the Gasserian ganglion
  • Balloon compression – where a tiny balloon is passed along a thin tube inserted through the cheek and is inflated around the Gasserian ganglion to squeeze it; the balloon is then removed