Facial Pain (Trigeminal Neuralgia)

Facial pain is one of the most distressing painful conditions. Almost all of them are neuropathic in origin (i.e. pain resulting from an abnormality affecting the nerves). The most common cause of facial pain is trigeminal neuralgia (or facial nerve pain). 

The pain, which comes and goes, feels like bursts of sharp, stabbing, electrical shocks involving the cheek, nose, upper lip or the jaw. In almost all cases (more than 95%), pain will be restricted to one side of your face. This pain can last from a few seconds to a few minutes. Common daily activities such as eating, drinking or brushing the teeth can bring on the pain. 

Compression of the trigeminal nerve by a blood vessel at the base of the brain may cause trigeminal neuralgia. Tumour and multiple sclerosis are other important causes. Unfortunately, the cause of trigeminal neuralgia is unknown and there is no disease involving the trigeminal nerve or the central nervous system. Thus controlling the pain is the mainstay of treatment. 

You should see a doctor to confirm the diagnosis. Your doctor will conduct an interview and physical examination. He may ask you specific questions regarding your pain, including onset, nature and triggering factors. He may also arrange for you to have a magnetic resonance imaging (MRI) of the brain. 

Your doctor may also refer you to a neurosurgeon if deemed necessary. 

Trigeminal neuralgia secondary to blood vessel compression of the trigeminal nerve can be treated successfully with a neurosurgical procedure called microvascular decompression. 

Other non-surgical causes of trigeminal neuralgia may respond to medical management with medications such as carbamazepine (Tegretol), phenytoin (Dilantin) or other medications for nerve pain. However, when unacceptable long-term side effects or inadequate pain relief happens, other invasive interventions may be indicated. Such interventional procedures include glycerol injection and radiofrequency lesioning. Your pain specialist will be able to discuss and advise you on the various options for treatment.