Continuing of very popular medical series Medical Matters, this week Dr Ciaran Roarty addresses the painful problem of Trigeminal neuralgia.
Trigeminal neuralgia is nerve pain involving one or more branches of the nerve that carries sensation from your face to your brain.
This nerve is called the trigeminal nerve or fifth cranial nerve. The pain can be severe and distressing and if left untreated can lead to depression and anxiety.
Thankfully this condition is not common – about 20 people in 100,000 develop it. This means that we can expect about 30 people in Donegal will develop this condition. It affects women more than men and it usually affects people over sixty.
How is it diagnosed Doctor?
Diagnosis is usually made based on typical symptoms and no tests are required. Occasionally an MRI is required if the diagnosis is in doubt, or the condition presents in a young person. If an unusual cause is suspected ( eg where other symptoms or complications are present), or treatment does not help, an MRI may also be required.
What causes Trigeminal Neuralgia?
We each have a Trigeminal nerve on either side of our face and each nerve has three branches. These branches ( and their smaller divisions) take sensations of touch and pain to the brain from our face. The trigeminal nerve also controls our chewing muscles along with saliva and tear production. In about 80% – 90% of cases it is thought that the cause of pain is related to a small artery or vein pressing on the nerve. Other causes of the conditions are much rarer and include tumours, MS or an abnormality of the base of the skull. It is very rare for both sides of the face to be affected.
Symptoms
Neuralgia means nerve pain and in this condition the patient gets sudden pains that come from one or more branches of the trigeminal nerve. The pain is usually around the cheek or jaw bone or both and usually on one side of the face. The pain is very sharp or piercing and is often described like electric shocks. It can last for seconds to minutes with gaps in between which can last minutes or even days. Sometimes the pain repeats in quick succession. After a painful attack your face may feel dull or achy. Constant unrelenting pain is not usually associated with Trigeminal Neuralgia.
Some people have trigger points on their face where the slightest touch or breeze trigger pain. This can interfere with eating shaving etc. Between attacks of pain there is usually no other symptoms and examination is unremarkable
The first bout of pain usually happens without warning and may last days weeks or months. Subsequent bouts of pain are unpredictable both in duration and frequency.
Treatment
Usually medication is used to reduce the pain. These are often not our typical painkillers or anti-inflammatories which don’t really work well for this condition. Don’t be surprised if your doctor prescribes certain medication that is normally used to treat epilepsy as this has been found to work well. If this doesn’t work well other medications are used. Medication works in the majority of cases. If medication is not effective other treatments tried include surgery and a newer pioneering treatment called deep brain stimulation.
The above information is intended as advice only and should you have any concerns contact your own Doctor.
Dr Ciaran Roarty MB BCh BAO MICGP DRCOG is a full-time GP at Scally McDaid Medical Practice, Scally Place, Letterkenny, Tel 0749164111
Doctors Dara Scally, Jimmy McDaid and Ciaran Roarty at their practice.
