The trigeminal nerve supplies sensation to the face. It is the fifth “cranial nerve” and is divided into three major branches, all of which supply specific facial regions. Trigeminal neuralgia is a condition of chronic pain caused by compression of the trigeminal nerve or, in some cases, by multiple sclerosis, a disease that strips away the coating of the nerve sheath. Tumors can also compress the trigeminal nerve, resulting in pain or damage. Injury may occur as the result of stroke, trauma, surgery of the sinuses or dental surgery.
The ophthalmic branch of the trigeminal nerve supplies the forehead, scalp and front of the head. The middle branch, called the maxillary branch, supplies the cheeks, upper portion of the jaw, top lip, teeth, gums, and side of the nose. The mandibular portion of the trigeminal nerve supplies the area known as the mandible or lower jaw, in addition to the teeth, gums, and bottom lip. Usually, only one half of the face is affected, although more than one branch of the trigeminal nerve may be involved on that side.
There are two types of trigeminal neuralgia. Type I results in intermittent and sudden burning pain, or shock-like pain lasting for seconds to minutes. The attacks may continue in rapid succession, and can last for several hours. Type 2 results in a different type of pain that is constant and usually less intense, sometimes described as an aching pain. However, the pain of Type 2 may also be burning or stabbing.
Movement or temperature may trigger pain associated with trigeminal neuralgia. It normally occurs in the daytime. Sometimes a patient may have a series of attacks, which resolve and don’t return until weeks or months later. However, progression of the disease results in shorter periods without pain, with more frequent occurrences. The pain can be debilitating and can result in limitation of activity or social isolation.
The diagnosis of trigeminal neuralgia must include tests to rule out other causes of facial pain, and frequently, imaging studies may fail to show the presence of a blood vessel compressing the trigeminal nerve. Treatment with an anti-epileptic medication is usually positive in Type 1 trigeminal neuralgia, and successful treatment sometimes confirms the diagnosis. In Type 2 trigeminal neuralgia, responses to therapy with tricyclic antidepressants may be useful. There are a series of procedures if more conservative therapy is unsuccessful.
If you are experiencing severe facial pain, you should call us today for help with evaluation and resolution of your disorder. We offer weekday and weekend appointments. You can find us at our conveniently located clinics in West Orange, Aberdeen, and Lyndhurst.