If you have been experiencing chronic facial pain, and you (or your doctor) have attributed it to a bad tooth, you may want to investigate further. A rare chronic condition that causes severe pain in the face is Trigeminal Neuralgia (TN), also known as tic douloureux. This condition affects the trigeminal nerve, one of 12 pairs of nerves attached to the brain. The three branches of this nerve support the travel of sensations from the upper, middle and lower areas of the face, as well as the mouth, up to the brain. TN is often initially misdiagnosed. While this condition is challenging, medical science is learning more about it, and there is hope for those who suffer.
Among the causes of TN are:
Pressure: blood vessel(s) pressing against the trigeminal nerve as it exits the brain stem.
Nerve compression from a tumor
Malformation of blood vessels
Injury (sinus surgery, oral surgery, stroke, or facial trauma)
Known triggers of TN are:
Vibration or contact with the cheek (sometimes caused by shaving, washing the face, or applying makeup)
Exposure to the wind
The symptoms depend upon the form of TN:
Typical or classic form (TN1): causes extreme, sporadic, sudden burning or shock-like facial pain that lasts anywhere from a few seconds to as long as two minutes per episode.
Atypical form (TN2): causes constant aching, burning, stabbing pain of somewhat lower intensity.
TN can affect more than one nerve branch, unfortunately. In rare cases, both sides of the face may be impacted at different times in one patient.
TN can be progressive. The attacks may stop for a while and then return, and the condition can be progressive.
Treatment is usually in the form of medication, which helps in as many as 80 to 90 percent of cases. Medications include:
Anticonvulsant medicines (antiseizure drugs)
Common analgesics and opioids
However, because TN is a progressive condition and can become resistant to medication, patients sometimes seek surgical treatment, such as:
A rhizotomy (rhizolysis): a procedure in which nerve fibers are damaged to block pain.
Balloon compression: this procedure works by injuring the insulation on nerves that are involved with the sensation of light touch on the face.
Glycerol injection: This is usually an outpatient procedure in which the individual receives intravenous sedation. Then a glycerol injection bathes the ganglion and changes the structure of the insulation of trigeminal nerve fibers.
Radiofrequency thermal lesioning
Stereotactic radiosurgery (Gamma Knife, Cyber Knife)
Microvascular decompression (MVD)
Neurectomy (partial nerve section)
The key to effective treatment is to correctly diagnose the problem at the onset, and to work with neurologists familiar with the disorder.