Trigeminal neuralgia: The name behind the indescribable facial pain

A patient visited my clinic complaining of excruciating facial pain, akin to electric shocks, recurring every hour for the past week.

Eating, talking, or even touching her face triggered this pain, severely impacting her life and causing depression. Despite prior consultations with various doctors and dentists and trying painkillers and antibiotics, her condition remained unresolved. After thorough examinations, she was diagnosed with trigeminal neuralgia (TN).

Trigeminal neuralgia, often termed the “suicide disease,” is a uniquely agonising neurological disorder affecting the trigeminal nerve responsible for facial sensation transmission. It’s a poorly discussed ailment with a worldwide estimated incidence of 5.5 per 100,000 individuals.

The hallmark of TN is sudden, severe facial pain resembling electric shocks or stabbing sensations, triggered by everyday activities like eating, speaking, or light facial contact.

One of its biggest challenges is its invisible nature to others, leading to misunderstandings about its severity. TN patients, though externally appearing well, suffer debilitating pain, causing social withdrawal and a diminished quality of life. The exact cause of TN isn’t always clear; it’s associated with pressure or damage to the trigeminal nerve, commonly affecting those aged 50-60. Factors like blood vessel pressure, intracranial lesions, or conditions like multiple sclerosis can also contribute, with genetics possibly playing a role.

TN typically showcases severe facial pain, commonly affecting one side but occasionally impacting both sides at different times. The pain, resembling sudden electric shocks lasting seconds to minutes, recurs throughout the day, causing immense distress. Seeking medical help is crucial if experiencing persistent facial pain not relieved by standard painkillers like paracetamol after dental issues are ruled out. Diagnosis involves a comprehensive medical history, neurological exams, and sometimes MRI scans to eliminate other potential causes.

Treatment for TN is complex. Medications like anticonvulsants (carbamazepine, gabapentin, pregabalin), muscle relaxants (baclofen), and occasionally opioids aim to alleviate pain. In severe cases, surgical interventions like injections, rhizotomy, decompression, or nerve ablation may be considered. Lifestyle adjustments, such as avoiding triggers, stress management, and sleep therapy, can help reduce pain frequency. However, treatment outcomes vary, and long-term management poses challenges.

TN’s impact is often underestimated, causing unimaginable suffering. Early diagnosis and timely intervention can significantly improve the affected individuals’ quality of life.

For the patient mentioned earlier, carbamazepine helped control her facial pain, allowing her to resume a normal life with regular clinic follow-ups.

Dr Tan Chuey Chuan is an oral and maxillofacial surgeon at the Faculty of Dentistry, Universiti Malaya, Malaysia.