When classifying the severity of chronic pain disorders, many people would agree that trigeminal neuralgia pain is the most challenging and painful conditions. Hard to diagnose, often unpredictable, and in some cases intractable, this disorder is frequently referred to as the “suicide disease” because of its severity. With a proper diagnosis and some persistence, there are treatment options for this pain condition that can make life better. Here are the 13 trigeminal neuralgia symptoms you should know – and three treatment options.
What is trigeminal neuralgia?
Trigeminal neuralgia, also referred to as TN pain or tic douloureux, is pain that originates in the trigeminal nerve. This nerve is one of 12 pairs of nerves that enervate the head, neck, and face. The trigeminal nerve is located on either side of the face just behind the ear.
There are three branches of the trigeminal nerve: the upper, medial, and lower. The upper branch controls sensation in the eye, upper eyelid, and forehead. The medial branch enervates the lower eyelid, cheek, nostril, upper lip, and upper gum. Finally, the lower branch controls sensations in the jaw, lower lip, lower gum, and some of the chewing muscles. Trigeminal neuralgia pain location depends on which branch of the nerve is affected (most commonly the lower branch).
In most cases, trigeminal neuralgia occurs only on one side, but those suffering from bilateral trigeminal neuralgia experience symmetrical pain on both sides of the face.
Approximately 150,000 people in the U.S are diagnosed with trigeminal neuralgia annually. The pain of this condition is so debilitating that it is sometimes referred to as the “suicide disease.” Patients diagnosed with this type of chronic pain often experience high rates of suicidal ideation and high rates of depression, anxiety, and sleep disorders.
Because it is commonly misdiagnosed as migraine, patients may experience no relief from treatment that does not address their actual condition.
What causes trigeminal neuralgia?
Trigeminal neuralgia causes are not definitive, but there are a few conditions that may trigger pain.
Blood vessels that press on the trigeminal nerve may cause damage to the protective coating on the nerve (the myelin sheath). Once this protective coating is gone, the nerve becomes sensitive. People with multiple sclerosis have a higher incidence of trigeminal neuralgia, as the disease causes wear on the myelin sheath as well.
Other potential trigeminal neuralgia causes include:
- Nerve compression by a tumor
- Arteriovenous malformation (tangled arteries and veins)
- Herpes zoster (shingles)
- Injury to the trigeminal nerve
Injury to the trigeminal nerve can be caused by injury to the face, oral or sinus surgery, or stroke.
What are the most common trigeminal neuralgia symptoms?
While trigeminal neuralgia and migraine share some symptoms, there are characteristics of trigeminal neuralgia that help patients receive an accurate diagnosis. Here are the 13 most common trigeminal neuralgia symptoms.
- Shooting pain
- Spontaneous pain
- Episodic pain
- Constant ache (in some cases)
- Burning sensation
- Pain on one side of the face
- Pain that is unresponsive to pain medication
- Uneven durations of pain
- Increasingly frequent attacks
- Ear pain
- Sensitivity to light
Here’s what you should know about each one.
The characteristic pain of trigeminal neuralgia is shooting pain that some patients describe as an electrical shock.
Perhaps the most challenging aspect of trigeminal neuralgia pain is the spontaneity of it. Even the slightest touch (like a breeze blowing across the face) can trigger pain.
Episodic pain is most characteristic of typical trigeminal neuralgia. Pain comes and goes with periods of relief. As the damage to the trigeminal nerve progresses, periods of remission become increasingly shorter.
A constant ache is not common for trigeminal neuralgia, but those who suffer from atypical trigeminal neuralgia (see below) cite this as their most prominent symptom.
Patients most often feel burning sensations in the initial stages of trigeminal neuralgia. In some cases, this may also be accompanied by a “fuzzy” type of feeling, as when a limb falls asleep. For most people, a mild burning sensation is one of the first symptoms they identify.
Pain on one side of the face
Trigeminal neuralgia pain occurs most often only on one side of the face. Because this pain is episodic and on one side, it can sometimes be misdiagnosed as a cluster headache.
Cluster headaches are also referred to as suicide headaches due to their intensity and resistance to treatment.
Pain that is unresponsive to pain medication
In the early stages, trigeminal neuralgia may respond to pain medication, but rarely. People who suffer from this pain report getting no relief from even the strongest prescription pain medications.
Uneven durations of pain
Attacks can last a few seconds or a few minutes (rarely longer). The unpredictable nature of trigeminal neuralgia pain is another feature of this condition that makes it especially difficult to live with.
Increasingly frequent attacks
As noted above, periods of remission are usually interspersed with painful episodes. Over time, these periods of remission become increasingly rare and may disappear altogether.
Trigeminal neuralgia ear pain may resemble an ear infection, except there are no physical signs of ear infection (e.g., swelling, redness, or excessive fluid in the ear).
The next three symptoms are why trigeminal neuralgia is frequently misdiagnosed as migraine. As with migraine, some trigeminal neuralgia sufferers experience nausea. This may be due to a variety of factors, including feelings of anxiety as painful episodes begin.
The stress and strain of dealing with a chronic disease may come with extreme fatigue, especially after a painful episode.
Sensitivity to light
Some patients experience sensitivity to light that is similar to migraine symptoms. This is not common and is not in and of itself enough to diagnose trigeminal neuralgia (or migraine, for that matter).
Atypical trigeminal neuralgia symptoms are more frequently burning and aching pain that is nearly constant and of somewhat lower intensity. This is sometimes referred to as Type 2 trigeminal neuralgia or TN2 (with typical trigeminal neuralgia referred to as Type 1 or TN1). Both types can have all of the symptoms as described above, but burning, constant aching is less common in Type 1.
Do I have trigeminal neuralgia?
Unfortunately, there is no definitive diagnostic test for trigeminal neuralgia. A proper diagnosis involves careful identification of the type and location of your pain, inc