Facial pain has a number of causes. Trigeminal neuralgia (TN) is named for the nerve (the trigeminal, or fifth cranial nerve) that is affected. Trigeminal neuralgia causes brief, intense, severe pain, usually on one side of the face or the jaw or near the eye. Trigeminal neuralgia is a type of neuropathicpain (pain caused by nerves).
Trigeminal neuralgia is more common in people older than 50 years and tends to affect women more than men. It may occur in other family members. Researchers think that TN is caused by pressure on the trigeminal nerve from a blood vessel. Persons with TN may be treated by neurologists, medical doctors who specialize in the treatment of conditions affecting the nerves and the brain.
Pain is sharp and can last a few seconds to several minutes. It often feels like an electric shock or stabbing but may feel like burning. There is no associated fever or swelling because it is not caused by an infection.
Pain may be triggered by simple actions such as chewing, brushing the teeth, puffs of air or wind on the face, or touching the face.
Episodes can come and go, sometimes with a long time between episodes (remission). The longer a person has TN, the shorter the remission periods. Some individuals have nearly constant episodes.
Because TN is chronic, unpredictable, and often severely painful, persons may also have depression or anxiety.
Trigeminal neuralgia is usually diagnosed by a medical history and physical examination. Other causes of facial pain should be considered because they may be treatable. Imaging studies such as magnetic resonance imaging (MRI) are often helpful to exclude other causes of facial pain.
Although TN is not curable, it can usually be managed like any chronic medical condition. It is not fatal.
Antidepressant medications and antiseizure medications are often prescribed for persons with TN because they often improve neuropathic types of pain. Narcotic pain medication tends not to be helpful.
It may help to avoid things that trigger the pain.
If severe TN is not manageable with medications, consultation with a neurosurgeon may be recommended. A neurosurgeon is a doctor who specializes in surgery of the nerves, the brain, and the spinal cord. Medical devices or specialized surgeries may be offered to persons with severe TN.
To find this and previous JAMA Patient Pages, go to the Patient Page Index on JAMA 's website at www.jama.com. Many are available in English and Spanish. A Patient Page on pain management was published in the November 12, 2003, issue.
Sources: National Institute of Neurological Disorders and Stroke, American Academy of Neurology
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Topic: NEUROLOGY