Terrible Facial Pain? Help for Former ‘Suicide Disease’

Easing the pain of trigeminal neuralgia

Trigeminal neuralgia can trigger unbearable pain on one side of the face. Small wonder that people once believed it drove sufferers to take their own lives.

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Today, medical advances have created better ways to manage the condition.

“A diagnosis of trigeminal neuralgia no longer means a lifetime of excruciating pain,” says Emad Estemalik, MD, an expert on headache and facial pain.

How pain develops

Trigeminal neuralgia is a disorder affecting the trigeminal cranial nerve, which carries sensations from the face to the brain.

When something compresses this nerve — often, a blood vessel in the brain — pain erupts on one the side of the face.

Those with the disorder often describe “stabbing” or “shock-like” pain that may last from several seconds to minutes at a time. Activities like eating, talking, brushing your teeth or shaving can prompt or aggravate the pain.

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“There are times when trigeminal neuralgia goes into remission and times when it comes back,” notes Dr. Estemalik.

Age increases risk

“It’s hard to predict who might develop trigeminal neuralgia. The condition can strike anyone,” he says.

Fortunately, it’s relatively rare. Only about 15,000 cases are diagnosed in the United States each year.

The risk for developing trigeminal neuralgia rises after age 50. (Women are at slightly increased risk.) Some evidence suggests trigeminal neuralgia may run in families, who inherit a similar blood vessel structure.

Making the diagnosis

Doctors take intense, one-sided facial pain seriously and must rule out all potential causes.

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“While most causes are benign, brain tumors and multiple sclerosis can present with the same symptoms,” says Dr. Estemalik.

They’ll do a neurological exam, considering the type of pain, its location and potential triggers. They may order an MRI or other tests as well.

4 treatment strategies

Dr. Estemalik outlines four options to help his patients manage pain:

  1. Medication: Doctors typically begin with anti-epileptic (anti-seizure) drugs or antidepressants. They may also prescribe “rescue medications” (muscle relaxers or narcotics) to help you cope with pain when it strikes.
  2. Surgery: Although “our primary goal is to delay surgery for as long as possible, about one-third of patients need it,” says Dr. Estemalik. One option is microvascular decompression surgery, which separates the trigeminal nerve from the brain vessel compressing it. Another is balloon compression surgery, which involves inserting a small balloon through the cheek and inflating it to limit the nerve’s ability to send pain signals. A third option is Gamma Knife radiosurgery, which precisely focuses radiation on the trigeminal nerve to help relieve pain.
  3. Pain blocks: Doctors can use injections and nerve blocks to ease pain temporarily.
  4. Psychological strategies: Biofeedback therapy and relaxation techniques can help manage the symptoms as well as the stress of chronic pain.

Cure remains elusive

Unfortunately, trigeminal neuralgia is a chronic condition that typically can’t be cured.

However, with the newer treatments available, most patients are able to manage their pain, says Dr. Estemalik. And the unfortunate nickname can be put to rest.

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