Trigeminal neuralgia (sharp face and jaw pain or burning)

By Dr Tariq Jagnarine
Fam Med, Endocrinology/Diabetes

Trigeminal neuralgia is a rare nerve disorder that causes sudden, sharp, and severe pain, usually on one side of the face. People describe it as a shooting, electric shock-like pain in the teeth, jaw, gums, and other areas. Trigeminal neuralgia is also known as tic douloureux. Some describe it as “the most excruciating pain known to humankind”. The pain is typically focused on the lower face and jaw, although it sometimes affects other areas of the face, such as around the nose and above the eyes.
Trigeminal neuralgia is caused by irritation of the trigeminal nerve, which starts at the ear and branches out to the forehead, cheeks, and lower jaw. Pain from this disorder is usually limited to one side of the face and can be triggered by actions such as eating or brushing teeth. Trigeminal neuralgia is a chronic pain disorder that affects the trigeminal nerve, also known as the fifth cranial nerve. It is a type of neuropathic pain, which is a pain associated with nerve lesions or injuries.
The most typical form of trigeminal neuralgia is type 1, or TN1, which causes attacks of sudden and severe facial pain. The pain can last between seconds and minutes. Attacks can occur one after another in cycles lasting as long as two hours.
Type 2, or TN2, is the atypical form of the disorder and is characterised by a constant pain that people have described as aching, stabbing, and burning at a lower intensity than TN1. A person may experience both types of pain, sometimes at the same time, which can be incapacitating.
Trigeminal neuralgia can affect more than one nerve branch, but it usually only affects one side of the face. Rarely, the disorder may affect both sides of the face, which is called bilateral trigeminal neuralgia.

Causes
Trigeminal neuralgia can be primary or secondary. If it is secondary, it means there is another condition that is causing the pain. This could be:
Cyst
Facial injury
Previous surgery
Multiple sclerosis (MS), or another condition that damages the protective sheath around nerves
In rare cases, a tumour
An MRI scan may be able to detect signs of some of these underlying causes.

Symptoms
Someone with trigeminal neuralgia may have one or more of the following symptoms:
Sudden attacks of severe, shooting pain in the face that last between seconds to around two minutes
Pain affecting one side of the face
Excruciating pain in the lower or upper jaw, teeth, or cheek, or — more uncommonly — in the forehead or eye
Sense that an attack of pain is about to happen, although they typically start suddenly
Slight ache or burning sensation after the most severe pain has subsided
Regular episodes of facial pain for days, weeks, or months at a time, which may disappear and not return for months or years
Trigeminal neuralgia can sometimes be progressive, with fewer pain-free days as time goes on. Pain attacks in trigeminal neuralgia can be triggered by: eating, drinking, brushing teeth, talking, wind blowing across the face, touching the face, such as when shaving
Atypical trigeminal neuralgia can be harder to diagnose than TN1. People often describe it as aching or burning rather than stabbing or shocking pain. Pain is usually less severe than with typical trigeminal neuralgia.

Diagnosis
Trigeminal neuralgia is often diagnosed by a dentist, as people often report pain in their teeth and jaws. A dentist may ask questions about the symptoms and perform a dental X-ray to rule out other, more common causes of facial pain, such as:
infection
TMJ disorder
cluster headaches
postherpetic neuralgia, which occurs after someone has shingles
A medical professional will usually diagnose the disorder based on a description of the pain and symptoms once they have ruled out other possibilities. Next, a doctor will typically order an MRI scan to see if there is an underlying cause for the condition.

Treatment
Trigeminal neuralgia is treatable with prescription medication and surgery.
Anticonvulsants
A doctor may prescribe a muscle-relaxing agent either alone or alongside anticonvulsants.
Surgery
Over time, trigeminal neuralgia can become resistant to pain-blocking medications. Some people also cannot tolerate the available drugs due to their side effects. In these cases, surgery is an option.
The options include:
Rhizotomy
A rhizotomy involves damaging the nerves in order to block pain signals. There are several types of rhizotomy.

Home remedies
The main home remedy people can use for trigeminal neuralgia is avoiding pain triggers. If a person can identify actions or events that cause an attack, they can adapt to avoid them in future. Some examples include:
Wearing a scarf over the face to protect against wind
Preventing drafts of cold air in the home
Sitting away from air conditioning units or fans
Avoiding spicy, hot, or cold foods
Using a straw to drink cold drinks
Eating mushy or liquid foods that do not require much chewing
***There is no evidence that home remedies can cure trigeminal neuralgia, but some people find complementary therapies helpful for managing the pain and the impact it has on their lives***. People may want to consider acupuncture, yoga, meditation, aromatherapy, biofeedback, and mental health support, etc.

Prevention
There are currently no guidelines on preventing the development of trigeminal neuralgia. However, people who already have the condition may be able to prevent attacks and pain by keeping track of potential triggers and avoiding them.