Trigeminal Neuralgia

Trigeminal neuralgia is an extremely painful condition usually involving one side of the face. It can occur spontaneously, but is sometimes associated with dental work or some sort of trauma. Described as a feeling of shock that runs along one side of the face in seconds, it can also occur in a repetitive fashion. Patients usually can identify possible triggers that cause the pain to occur.

What are some common triggers for the pain of trigeminal neuralgia?

• Eating, drinking, chewing or talking
• Shaving
• Touching the face
• Brushing the teeth
• Water hitting the face when taking a shower
• Touching a tooth or the lip with the tongue
• Feeling a slight wind or breeze on the face
• Sometimes, nothing at all

Intensity of pain
The intensity of the pain is exceptional, and it is felt to be as or more severe than having a baby. The pain is often dismissed by those who have not experienced in, but it is a terrible, life-altering pain.

The dental connection with trigeminal neuralgia
Frequent toothaches involving many teeth are a sign of pretrigeminal neuralgia, which may or may not get worse over time and convert to trigeminal neuralgia. Unfortunately, it is not commonly recognized that most "electric shooting pain" is caused by muscle spasms secondary to dental problems.

Who gets it and why?
Trigeminal neuralgia seems to occur much more often in women than men. It seems to be more common in older patients (usually more than 60 years), and it occurs more on the right than the left. It is not usually a genetic trait. It can be very active for a time, and then seem to disappear, sometimes for long periods, but always recurs later, often with more intensity.

The most commonly accepted theory of what causes trigeminal neuralgia is vascular compression. There are blood vessels that travel with the nerve, and if they cause pressure on the nerve or irritate it, pain can occur. In addition, some demyelinating conditions, such as multiple sclerosis, can have adverse effects on nerves, including the trigeminal nerve and cause neuralgia. There is controversy over post-herpetic neuralgia (caused by shingles) and whether it can be related to this condition.

Diagnosis
Trigeminal neuralgia is one of the most frequently misdiagnosed diseases by physicians. The only way to diagnose this disorder is by taking a careful history to determine the quality and quantity of the pain, its triggers, and what makes it feel better or worse. In other words, you need to be very detailed in your description, and your clinician needs to listen carefully.