Trigeminal neuralgia, also known as tic douloureux, is a disorder of the trigeminal nerve, a cranial nerve that senses touch, pain, temperature and pressure on the face and transmits sensation from the face to the brain. The condition you have can be excruciating, marked by sudden, intense facial pain most often described as “stabbing” or “lightning-like.” Often, it is triggered by touching a particular spot on your face but it can also be set off by doing something as routine as brushing your teeth, chewing, or putting on makeup. Even a cold breeze or wind can cause it, or it can occur with no particular stimulus.
Episodes can strike as rarely as a few times a month or year or as frequently as many times a day, which can be incapacitating. They can last for as little as two seconds or as long as two minutes. This is “Type 1” trigeminal neuralgia. Less common “Type 2” can cause constant aching, burning, stabbing pain that is somewhat less intense. Both types can occur in the same patient. The good news is that spontaneous remissions of this painful condition are common.
In most cases, a cause cannot be found. Sometimes, an out-of-place blood vessel compresses the nerve. In rare cases the condition is related to a tumor or, even less often, to an unusual type of stroke. As many as eight percent of multiple sclerosis patients develop trigeminal neuralgia due to the wearing away of part of the protective covering (myelin sheath) that insulates nerve fibers. Overall, the condition is more common in women and in those older than 50.
Treatment usually begins with the anticonvulsant drug carbamazepine (Tegretol), which usually works well, although its effectiveness tends to wane over time. Side effects may include dizziness, drowsiness, double vision and nausea.
I recommend considering a calcium/magnesium supplement, which can help calm overactive nerves, as well as trying acupuncture and hypnosis. And you might experiment with an extract of lion’s mane mushroom (Hericeum erinaceus), which supports healthy nerve function.
If medication doesn’t help, surgical treatment may be recommended. Several procedures are available, but I consider them drastic options to be considered only as last resorts. None works permanently to eliminate the pain, and some result in facial numbness. Depending on the procedure recommended, you may need repeat surgery as often as every year or two. And there’s no guarantee that it will help. A possible alternative is peripheral nerve blocks, effected by injections of local anesthetic. A study from Boston University Medical School published in November 2018 found that this treatment worked well for the nine patients tested – six reported continued pain relief for up to eight months and two said their pain resolved completely. More research is needed to confirm these initial findings.
Andrew Weil, M.D
Michael D. Perloff, Justin S. Chung. “Urgent care peripheral nerve blocks for refractory trigeminal neuralgia.” The American Journal of Emergency Medicine, November 2018; DOI: 10.1016/j.ajem.2018.08.019