Trigeminal neuralgia is a chronic condition involving short bursts of pain that affect areas of the face, teeth or inside the mouth.
The pain can be anything from a mild ache to severe pain that can be ‘stabbing’, ‘intense’ or ‘shooting’. Some attacks can last just seconds, others last several minutes.
Trigeminal neuralgia attacks vary in frequency, with some people having over 100 per day, but others only a few. Many people with trigeminal neuralgia experience long periods without attack, only to then experience a return of intense attacks with little warning. In many people, attacks are triggered by specific events, such as going out in a cold wind.
Trigeminal neuralgia tends to affect older people more than younger, and becomes more severe as they age. It is more common in women than in men, and affects about one in 1,000 people.
What causes trigeminal neuralgia?
Trigeminal neuralgia is thought to arise when pressure from blood vessels compresses the trigeminal nerve. There are 2 trigeminal nerves; one on the left side of the face and one on the right. Each has 3 divisions with branches of the nerve going to the forehead, the cheek and the jaw on each side. The nerves are mainly sensory and they send information from the skin and the face back to the brain. The branch of the trigeminal nerve that goes to the jaw also carries signals from the brain to the muscles to get the jaw to move. This is important for chewing and speaking.
The trigeminal nerve usually gets compressed as it emerges from the base of the brain. The compression damages the myelin sheath that usually protects nerve cells. The damage can then cause trigeminal neuralgia as the nerve becomes exposed and inflamed. Any branch of the nerve can be affected but, in most cases, trigeminal neuralgia affects only one side of the face.
Factors that are known to cause nerve compression include trauma, such as car accidents, and brain tumours. Despite thorough investigation, many people who develop trigeminal neuralgia never find out exactly what triggered it.
Do I have trigeminal neuralgia?
Diagnosing trigeminal neuralgia relies heavily on how well you are able to describe what you are feeling during an ‘attack’. It is important to describe your symptoms in as much detail as possible to your GP.
Symptoms of trigeminal neuralgia overlap with those of many other conditions, including dental problems and migraine and, in fact, most facial pain is not caused by trigeminal neuralgia. Your GP will want to rule out all other possible causes and you may need to be referred to a neurologist or other specialist before you can get a firm diagnosis.
MRI scans can help confirm that you have trigeminal neuralgia, but it is not a precise tool for this particular condition. Only around 15% of all cases of trigeminal neuralgia are confirmed by an MRI scan.