What is it about ?
Trigeminal neuralgia
The trigeminal nerve is a nerve in the skull that performs several functions, for example the sensitivity of the face.
Trigeminal neuralgia is a condition characterized by attacks of intense pain on one half of the face. It is usually caused by a blood vessel pressing on the trigeminal nerve. Sometimes it is caused by another disease such as multiple sclerosis. It also happens that the cause cannot be found.
Other facial pain
Pain associated with involvement of the trigeminal nerve (neuropathic pain). The nerve can be affected by injury, sinus surgery, viral herpes infection, or after a stroke.
Acute facial pain. Sharp pain in the face can be caused by sinusitis, a dental problem, a neck condition (such as inflammation of the thyroid), or tension in the muscles of the back of the neck. These are also the most common causes of acute facial pain.
Atypical facial pain, also called persistent idiopathic facial pain. It is a form of prolonged facial pain that is much more common than trigeminal neuralgia. It mostly affects middle-aged women.
How to recognize them?
Trigeminal neuralgia
You suffer from severe pain attacks on one half of your face. The pain looks like electric shocks. Seizures can be triggered by eating or touching certain parts of the face. When the pain is at its most, it is sometimes impossible to wash your face, brush your teeth, speak, eat or drink.
Between attacks, you have no pain.
Other facial pain
Pain related to the involvement of the trigeminal nerve (neuropathic pain): the pain is present permanently for a certain time, it does not manifest itself in the form of seizures.
Atypical facial pain: the pain is constant and radiates all over the face. It can be triggered by sinus or tooth surgery, infection, or stress.
How is the diagnosis made?
Your doctor will ask you very specific questions and examine you. He may examine the teeth, chewing muscles, jaw joints, cervical vertebrae, cervical and shoulder muscles, as well as the ears, nose, throat and neck. An examination of your nerves is also possible.
Depending on his observations, the doctor will refer you to a specialist. This can be a dentist, a mouth specialist (stomatologist), a nose, throat and ear specialist (otolaryngologist) or a nervous system specialist ( neurologist). He may also refer you to a clinic specializing in pain management.
What can you do ?
Your story is important to your doctor: it helps them find the cause of your facial pain and make the correct diagnosis. Try to describe your symptoms as clearly as possible.
Be sure to follow your doctor’s advice: go to a specialist if your doctor advises you and follow the prescribed treatment.
Report promptly if you have any side effects from the treatment. For example, if the dose of carbamazepine is too high, you may feel dizzy, tired, double-eyed, or have moving eyes.
Try to avoid the triggers: wear a scarf in front of your face in cold weather and try not to touch the sensitive area.
What can your doctor do?
Trigeminal neuralgia
If you are diagnosed with trigeminal neuralgia, your doctor may suggest treatment with an anti-seizure medicine that works for pain, carbamazepine.
At the start of treatment, the doctor will regularly check your blood cells and how your liver is working by blood tests. If you feel dizzy or tired, see double, or move your eyes on their own, your doctor may check the level of carbamazepine in your blood. The dose of carbamazepine may be too high. In this case, your doctor may lower the dose or switch to another medicine.
After a few months, the doctor will try to reduce the drugs, because trigeminal neuralgia often improves spontaneously.
If the medicine does not or does not provide enough relief, it is possible to think about an operation. Two techniques are possible: destroy the trigeminal ganglion or free the trigeminal nerve from the small artery which compresses it.
Other facial pain
Treatment for other facial pain depends on its cause. If necessary, your doctor will advise you with a specialist or dentist. These pains are usually treated with anti-seizure drugs and antidepressants.
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