Facial Pain Trigeminal Neuralgia | Noida Pain Management Clinic

Trigeminal neuralgia is a very painful facial pain that usually affects one side of the face. These patients have electric shock or stabbing-like episodes of pain lasting for a few seconds. In between these painful episodes, the patient can have pain-free intervals for minutes, hours, or even days.

These episodes can occur on their own but also by touching the face, brushing, shaving, biting, or even chewing something. Any of these activities may “Trigger” the episodes of pain. This is unlike dental pain where the patient massages or applies heat/cold to get relief.
Cause- This pain is due to a dysfunction of the trigeminal sensory system. It can be 1- Primary (Type 1) which has no cause or is idiopathic or Secondary (Type 2) which results from compression or irritation, any tumor, or a disease like multiple sclerosis.

Which kind of patients have Trigeminal Neuralgia -

Mostly it affects patients over 50 years of age, although it can occur at any age.
Women are affected twice as often as men

Which part of the face is affected by trigeminal neuralgia -
Since Trigeminal neuralgia has 3 divisions, patients can have pain in the corresponding part of the face-

When 1st division (Ophthalmic) is affected, patients have pain in their forehead and also up to the upper part of the head.
When 2nd division (Maxillary) is affected, patients have pain around the cheek and in front of the ear and upper jaw.
When 3rd division (Mandibular) is affected, patients have pain in the lower jaw and tongue.
Mostly 2nd and 3rd divisions are affected but all or any two can also be affected apart from the single nerve being affected

Diagnosis of Migraine- Trigeminal Neuralgia diagnosis is made by a doctor by clinical examination of the patient after a detailed history. There is no test that is confirmatory for the diagnosis of this condition. Mostly a simple MRI of the brain is advised so that any other disease of the brain is ruled out.

Other painful conditions which can look like Trigeminal neuralgia -

Cluster tic - Sometimes a patient may have both Trigeminal neuralgia and cluster headache.
Glossopharyngeal Neuralgia - In this condition, there is severe stabbing or burning pain felt in the ear, base of the tongue, tonsillar fossa, or area beneath the angle of the jaw. The pain can be started by chewing, swallowing, talking, yawning, or coughing.
Geniculate Neuralgia - It is an unusual condition caused by impairment of the sensory part of the Facial nerve. In general, it is related to a herpes zoster infection of the geniculate ganglion. There is severe pain in and outside of the ear.
Postherpetic Neuralgia of the Trigeminal Nerve - When the infection occurs in persons more than 70 years of age, it may persist for long. The pain is one one side of face with a burning quality. Involvement of the forehead is most common.
Atypical facial pain – This is a deep burning pain that is continuous and poorly localized and common in middle aged females. Sleep and facial functions, such as eating and talking, are rarely affected, except when pain is located intraorally.

Management- The medical treatment of Trigeminal neuralgias is aimed at decreasing nerve hyperexcitability, either peripherally or centrally. Clinically, pharmacologic therapies are aimed at providing rapid and sustainable pain relief with the least number of side effects. Management of Trigeminal neuralgia at Noida Pain Management Clinic involves the following-

Medicines- Unlike routine pain where painkillers are used, TN treatment is done with neuropathic medicines. Most patients get long-lasting relief. with the use of medicines. There are more than 6-7 types of nerve medicines for TN like Carbamazepine, which are very helpful for most patients. Almost 70% of trigeminal neuralgia patients can be easily managed with medicines.
Remission- Sometimes a patient may stop having painful attacks on medicines and in this case, medicines can be decreased. Under no circumstances, the patient should stop medicines on his own as he may have very severe pain which will be more difficult to control.
Percutaneous block by alcohol or glycerol. – In those not responding to medicines or having side effects with medicines, these blocks are extremely useful. Patients may have long-lasting relief up to a year or more following these blocks.
Surgery is also employed in patients sometimes.

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Facial Pain- Trigeminal Neuralgia | Noida Pain Management Clinic