What is Trigeminal Neuralgia?
The trigeminal nerve is one of the most widely distributed nerves in the head and is anatomically classified as the 5th cranial nerve. Trigeminal neuralgia is a chronic pain condition affecting this nerve. In trigeminal neuralgia, there is a type of neuropathic pain that causes sudden facial pain with a burning or electric shock sensation, occurring at irregular intervals.
In the image below, you can observe the three main distribution areas of this nerve on the face. The disease typically affects the maxillary (V2) and mandibular (V3) branches.
Trigeminal neuralgia pain has highly typical characteristics. A major part of the diagnosis is established based on how the patient describes this pain.
- Pain Character: The pain is described as an electric shock, a stabbing sensation, or a lightning strike. It is very sharp and sudden, rather than dull or aching.
- Location and Radiation of Pain: It is almost always unilateral. The incidence of affecting the right side is slightly higher. It is felt around the eyes, in the cheek, teeth, lips, or jaw.
- Duration and Frequency of Pain: Attacks last from a few seconds to a few minutes (usually less than 2 minutes). However, in severe cases, they can occur in succession, creating prolonged states of "status neuralgicus" (a relentless storm of pain).
- Pain Triggers: Patients have "trigger points" on their faces. Wind touching the face, light touch, brushing teeth, shaving, eating, chewing, speaking, and even smiling can initiate an attack.
- Pain-Free Intervals: Between two attacks, the patient is generally completely pain-free. However, not knowing when the next attack will occur causes severe anxiety.
Causes of Trigeminal Neuralgia
Causes of trigeminal neuralgia include blood vessels compressing the trigeminal nerve, which is the most common etiology; however, in some cases, the cause remains unknown. The most common blood vessel causing compression on the trigeminal nerve and subsequent trigeminal neuralgia is the superior cerebellar artery or a branch of this artery. Occasionally, one or more large veins can also irritate or compress the nerve, leading to this condition. These vessels can compress or irritate the nerve between its exit from the brainstem and its entry into the skull base due to pulsations or pressure changes.
In rare cases, tumors located along the path of the trigeminal nerve in these or other regions may be responsible for trigeminal neuralgia. In some cases, trigeminal neuralgia may be associated with multiple sclerosis (MS).
The Importance of Accurate Diagnosis and Expert Opinion
Since this condition can be confused with other craniofacial (head and face region) pain syndromes, it is crucial for patients to seek the opinion of a trigeminal neuralgia specialist to assist in establishing a diagnosis. Trigeminal neuralgia specialists are typically neurologists, neurosurgeons, otorhinolaryngologists (ENT specialists), or craniofacial pain specialists.
Other conditions that can mimic trigeminal neuralgia include the following:
- Temporomandibular joint (jaw joint) pain or jaw pain.
- Sinus infections or other sinus disorders.
- Dental conditions, including cavities, infections requiring root canal treatment, hypersensitive teeth, and other dental pathologies.