Trigeminal Neuralgia - Facial Pain

Trigeminal neuralgia is a disorder of a nerve that results in episodes of severe excruciating facial pain. This nerve normally supplies feeling to the face. This nerve – the trigeminal nerve (5th cranial nerve) – branches into three divisions as it leaves the skull, one supplying sensation to the forehead, one to the cheek, and one to the lower jaw. Any or all of the three divisions may be affected.

Patients with trigeminal neuralgia usually experience episodes of electric shock like, shooting, or excruciating spasms of facial pain. They may initially experience short, mild attacks, but trigeminal neuralgia can progress, causing longer, more frequent bouts of debilitating pain. This pain may be so severe that the patient may cry out or visibly wince. The affected area of the face may become super-sensitive and minor stimulation such as a light breeze, cold temperature, water from a shower, washing the face, shaving, or even eating can trigger attacks of pain.

A wide range of conditions that irritate the nerve can lead to this painful disorder. The most common cause of trigeminal neuralgia is a small loop of a blood vessel that compresses the nerve as it exits from the brainstem. Other potential causes include multiple sclerosis, tumor, trigeminal nerve injury or an inflammatory disorder that damages the protective insulation of the trigeminal nerve. Initial workup usually includes an MRI scan of the brain, given with an intravenous contrast dye. This scan is negative in the majority of cases however it is necessary to rule out structural or inflammatory brain lesions and to identify potential offending blood vessels.