Trigeminal Neuralgia

Friends, have you come across a condition called TRIGEMINAL NEURALGIA?

It is a condition that causes intense pain similar to an electric shock on one side of the face. It affects the trigeminal nerve, which carries signals from the face to the brain. Even a light touch, such as brushing teeth or putting on makeup, triggers a jolt of pain. Trigeminal neuralgia can be long-lasting. It’s known as a chronic pain condition. People with trigeminal neuralgia at first experience short, mild episodes of pain. But the condition can get worse, causing longer periods of pain that happen more often. It is common in women and people older than 50. The condition of trigeminal neuralgia can be managed with treatment.

SYMPTOMS

The symptoms may include one or more patterns:

• Episodes of intense shooting or jabbing pain that may feel like an electric shock.
• Sudden episodes of pain or pain triggered by touching the face, chewing, speaking or brushing your teeth
• Episodes of pain lasting from a few seconds to several minutes.
• Pain that occurs with facial spasms.
• Episodes of pain lasting days, weeks, months or longer. Some people have periods when they experience no pain.
• Pain in areas supplied by trigeminal nerve. These area include the cheek, jaw, teeth, gums or lips. Less often, the eye and forehead may be affected.
• Pain on one side of the face at a time.
• Pain focused in one spot. Or the pain may be spread in a wider pattern.
• Pain that rarely occurs while sleeping.
• Episodes of pain that become more frequent and intense over time.

See your healthcare professional if you experience pain in your face, particularly if it’s long-lasting or comes back after going away. Also get medical attention if you have chronic pain that does not go away with pain medicine that you buy off the shelf.

CAUSES

In trigeminal neuralgia, the trigeminal nerve’s function is disrupted. Contact between a blood vessel and the trigeminal nerve at the base of the brain often cause pain. The blood vessel may be artery or a vein. This contact puts pressure on the  nerve and doesn’t allow it to function as usual. But while compression by a blood vessel is a common cause, there are many other potential causes. Multiple sclerosis or a similar condition that damages the myelin sheath protecting nerves can cause trigeminal neuralgia. A tumor pressing against the trigeminal nerve also can cause the condition. Some people may experience trigeminal neuralgia as a result of stroke or facial trauma. An injury of the nerve due to surgery also can cause trigeminal neuralgia.

RISK FACTORS

Research has found that some factors put people at higher risk of trigeminal neuralgia, including:

• Sex- Women are more likely than men to experience trigeminal neuralgia.
• Age- Trigeminal neuralgia is more common among people 50 and older.
• Certain Conditions- For example, hypertension is a risk factor for trigeminal neuralgia. In addition people with multiple sclerosis at at higher risk of trigeminal neuralgia.

DIAGNOSIS

It is mainly clinical based on patient history and symptoms. However certain investigations help rule out secondary causes:

• Neurological Examination- It is applicable in the case of classical Trigeminal neuralgia.
• MRI- It can detect vascular compression, multiple sclerosis plaques or tumours.
• Magnetic Resonance Angiography (MRA)-It can identify blood vessel abnormalities near the nerve.

TREATMENT OPTIONS

1 Medications (First-Line)

• Carbamazepine-the gold standard drug, effective in most cases but may cause dizziness, nausea, or liver/blood complications.
• Oxcarbazeepine- alternative with fewer side affects.
• Other drugs- Gabapentin, Pregabalin, Baclofen, Lamotrigine 0to be used if first-line drug fail).

2 Surgical and Interventional Treatments

If medications are ineffective or poorly tolerated

• Microvascular Decompression (MVD)- A neurological procedure where the compressing vessel is moved away from the trigeminal nerve. This offers long term relief in many patients.
• Gamma knife Radiosurgery-Non invasive, uses focused radiation to damage the nerve root and reduce pain.
• Rhizotomy- It involves damaging the nerve fibres to stop pain signals. This can be done by different types like balloon compression, glycerol injection or radiofrequency thermal lesioning.

3 Supportive Therapies

• Physiotherapy and relaxation techniques to ease secondary muscle tension.
• Psychological support for anxiety and depression.
• Lifestyle adjustments (avoiding known triggers, soft diet, stress reduction)

It is not a life threatening condition, but its pain can be intense. Many patients achieve good pain control with medications or surgery. Some require multiple procedures over a lifetime as recurrences are common. Early diagnosis and treatment improve quality of life significantly.

In the end, trigeminal neuralgia is a chronic but manageable condition. With appropriate medical and surgical treatment, many patients achieve substantial relief. Because it affects not only physical health but also mental well-being, a multidisciplinary approach involving neurologists, neurosurgeons, and psychologists is often most effective.

Famous Bollywood celebrity Salman Khan is suffering from this condition for last so many years, with treatment it is much better now.

Waiting for your feedback on this blog.

Anil Malik

Mumbai, India

1^st October 2025