Trigeminal Neuralgia

Trigeminal neuralgia is a chronic pain condition that affects the trigeminal nerve, one of the most important nerves in the head, responsible for carrying sensations from the face to the brain. This condition can cause sudden, severe, and debilitating facial pain. For those experiencing trigeminal neuralgia, understanding its causes, symptoms, and available treatment options can be vital for finding relief and improving quality of life.

What Is Trigeminal Neuralgia? What Are the Types of Trigeminal Neuralgia?

Trigeminal neuralgia is a nerve disorder that causes intense, shock-like facial pain, often triggered by everyday activities such as chewing, speaking, or even brushing teeth. It occurs when the trigeminal nerve, which transmits sensory information from the face to the brain, becomes irritated or compressed.

There are two types of trigeminal neuralgia:

1. Classic Trigeminal Neuralgia (Type 1): This form presents with sudden, severe, and sporadic pain, lasting from a few seconds to several minutes. The pain can come and go over weeks or months.
2. Atypical Trigeminal Neuralgia (Type 2): This type is characterised by more constant pain, though less intense. It may feel like a burning or stabbing sensation, making it harder to diagnose.

What Causes Trigeminal Neuralgia?

Trigeminal neuralgia is primarily caused by compression of the trigeminal nerve, often by a nearby blood vessel pressing against it. This pressure can wear away the protective coating of the nerve (the myelin sheath), causing it to misfire and send pain signals to the brain.

Other potential causes include:

• Multiple sclerosis: A disease that causes nerve damage and can affect the trigeminal nerve.
• Tumours or cysts: Though rare, growths near the trigeminal nerve can cause compression.
• Injury: Facial trauma, dental surgery, or accidents can damage the nerve and trigger trigeminal neuralgia.
• Age-related wear and tear: Trigeminal neuralgia is more common in older adults, often due to age-related changes in blood vessels or nerves.

What Are the Symptoms of Trigeminal Neuralgia?

The primary symptom of trigeminal neuralgia is intense facial pain. This pain is typically:

• Sudden and severe: The pain often feels like an electric shock or stabbing sensation.
• Short-lived but recurring: Pain episodes can last for a few seconds or minutes but may recur frequently.
• Triggered by simple activities: Common triggers include brushing teeth, eating, talking, or even exposure to wind.

In some cases, people may also experience facial twitching, sensitivity, or discomfort even in the absence of pain episodes.

Is Trigeminal Neuralgia Painful?

Trigeminal neuralgia is widely regarded as one of the most painful conditions known. The sudden, intense jolts of pain can be overwhelming and significantly impact daily life. Many patients describe the pain as unbearable, and it can severely affect activities like eating, talking, or even smiling. Pain severity varies, but without proper management, it can become chronic and progressively worsen over time.

Who Is at Risk of Getting Trigeminal Neuralgia in Singapore?

Several factors increase the risk of developing trigeminal neuralgia:

• Age: While trigeminal neuralgia can occur at any age, it is most commonly diagnosed in people over the age of 50.
• Gender: Women are more likely than men to develop this condition.
• Multiple sclerosis: Individuals with multiple sclerosis have a higher risk of developing trigeminal neuralgia due to the damage to their nerves.
• Family history: Some studies suggest a genetic predisposition, where individuals with a family history of the condition may be at higher risk.

How Is Trigeminal Neuralgia Diagnosed?

Diagnosis of trigeminal neuralgia typically involves a thorough medical history and a physical examination. Neurologists often focus on:

• Pain history: Describing the nature of the pain, its triggers, and its duration helps differentiate trigeminal neuralgia from other types of facial pain.
• Neurological exam: A physical examination will assess facial sensations and reflexes to help locate any abnormalities.
• MRI scans: Imaging techniques, particularly magnetic resonance imaging (MRI [link to MRI]), can detect any abnormalities such as blood vessel compression, multiple sclerosis, or tumours that may be causing nerve damage.

What Are the Treatment Options for Trigeminal Neuralgia in Singapore?

Treating trigeminal neuralgia focuses on reducing the frequency and intensity of pain episodes, and multiple treatment options are available:

1. Medications:
   • Anticonvulsants: Medications like carbamazepine or gabapentin are often prescribed to reduce nerve pain by stabilising electrical activity in the nerves.
   • Muscle relaxants: These drugs can help manage pain in some patients, especially those who do not respond well to anticonvulsants.
   • Painkillers: While regular painkillers are often ineffective for trigeminal neuralgia, stronger medications like opioids or analgesics may be used in some cases.
2. Surgery:
   • Microvascular decompression (MVD): This procedure involves relieving pressure on the trigeminal nerve by repositioning or removing any blood vessels compressing it.
   • Gamma Knife radiosurgery: This non-invasive procedure delivers precise radiation to the trigeminal nerve, reducing its ability to transmit pain signals.
   • Rhizotomy: This procedure involves damaging specific nerve fibres to reduce pain transmission.
3. Other treatments:
   • Nerve blocks [link to Nerve blocks]: Injecting anaesthetic agents into the nerve can provide temporary relief.
   • Botox injections: Botox has been shown to help reduce nerve pain in some patients.

Trigeminal neuralgia is a severe, debilitating condition that requires prompt diagnosis and appropriate treatment to manage the intense pain it causes. Schedule a consultation with Dr Charles Siow for proper evaluation and personalised treatment.