Earlier this year I wrote a post about Temporomandibular Disorder (TMD); jaw joint dysfunction, which my mother suffers from. She has recently visited a specialist who has recognized that this condition is a consequence of trigeminal neuralgia. By looking into my mother’s medical history, the disorder is likely to have been caused after she had surgery to remove her wisdom tooth, in which her jaw was opened too far.
What is Trigeminal Neuralgia?
It is described to be a sharp, shooting facial pain which can last from a few seconds to around 2 minutes. Commonly it only affects one side of the face, in my mother’s case it is her left side. These attacks can happen up to hundreds of times a day, although most people experience it daily or weekly. This pain can improve or disappear, however with my mother the condition has developed into a more continuous throbbing ache, along with random sharp attacks. My mother is normally triggered when she over exerts herself, is exposed to cold wind or harsh weather. In other people a simple movement of the face or head can sometimes activate the pain.
What is the Trigeminal nerve?
The compression of this nerve which is the largest inside the skull is the main cause of Trigeminal Neuralgia. There are actually two sets of the nerve in both the left and right side of the face. Figure 1 shows how extensive the Trigeminal nerve is; it lengthens into smaller branches such as the Mandibular branch which sends sensory information from the skin to the lower jaw, teeth and gums. Typically either the Mandibular branch or the Maxillary branch (upper jaw) is affected. The exact cause of the condition remains unknown; however 95% of cases seem to be caused when pressure is caused by an artery or vein compressing the Trigeminal nerve. In this way the pressure causes the myelin sheath which protects the outer layer of a neuron to wear away which causes the uncontrollable pain signals to occur. However, accepting this as a cause in contradictory as it does not explain why sufferers experience pain periodically with times when there are no symptoms.
How is the condition treated?
Painkillers such as paracetamol are ineffective at treating this condition therefore anticonvulsant medication is usually prescribed. The only current type of this medication licensed for such treatment is called Carbamazepain. Unfortunately although the initial effect of this medication is effective, in the long-term it becomes more ineffective. In addition it has various side effects such as double vision, memory problems and allergic skin reactions. Hence, patients are normally referred for further treatment. In serious cases when medication is inadequate surgery may be necessary. Procedures may involve injection, for example glycerol injections into the Gasserian ganglion (where the 3 branches of the trigeminal nerve come together); this works by intentionally injuring the nerve so that it disrupts the pain signals travelling along it. This type of surgery has various complications such as numbness to part of or the entire side of the face. Indeed, the treatment will only cause the pain to be relieved for up to a few years so the consequences have to be considered before such treatment.
My mother has been referred to a specialist who will hopefully be able to assign an appropriate treatment for her condition. Living with the pain can be extremely difficult for her and sometimes her quality of life is affected considerably. In the meantime she tries to avoid doing activities that trigger her symptoms as it is important to live a normal life. If you experience persistent facial pain and find that normal painkillers do not suffice, you may want to consult your GP to see if Trigeminal Neuralgia is a potential cause. For more information on the condition visit: http://www.tna.org.uk/; the Trigeminal Neuralgia Association for the UK.