Case Studies in Headache Archive: Treating Trigeminal Neuralgia

By Edmund Messina, MD, Medical Director of the Michigan Headache Clinic in East Lansing, Michigan

While headaches are typically thought to be located around the forehead or back of the head, there are types of headache that strike the face itself. Trigeminal neuralgia is a form of severe facial pain in which patients experience brief volleys of very painful electric shock sensations triggered by mild touch to the face or mouth. This touch can be from washing, shaving, eating, brushing the teeth or even talking. The trigger zones are particularly sensitive in the area between the nose and mouth or on the chin. Continue Reading


Surgery No Longer Last Resort for Trigeminal Neuralgia

Surgery may be a better option for individuals with trigeminal neuralgia than second-line drugs, according to new American Academy of Neurology guidelines.

Trigeminal neuralgia (also known as tic douloureux) generally strikes people over age 50. The pain is an intense, burning sensation on one side of the face, often set off by touch, chewing, laughing, talking or even a cold breeze. The intermittent jabs of pain last for approximately 30 seconds, followed by a few pain-free moments, and then another group of painful jabs, which may reoccur for a few hours at a time. The attacks can go on for weeks or months. Continue Reading


Case Studies in Headache: Trigeminal Neuralgia

By David M. Biondi, D.O.
Director, Headache Management Program, Spaulding Rehabilitation Hospital and Instructor in Neurology, Harvard Medical School

THE CASE

James is a 65-year-old man who woke one day with severe pain on the right side of his face. The pain, which seemed to tear through his face like a lightning bolt, lasted only a few seconds, but then returned. For weeks, he had been experiencing dozens of these excruciating electrical shock-like attacks. James could no longer shave the right side of his face, brush his teeth, chew foods or talk for any length of time without triggering the repeated jolts of pain. He could not even tolerate a light breeze blowing across his face. James’ dentist could find no problems with his teeth or jaw and over-the-counter pain relievers provided no benefit. Continue Reading


Facial Pain

Chronic facial pain can be very confusing both to the patient and healthcare provider. This can be direct pain – involving nerves that supply the face or indirect (referred) pain from other structures in the head such as blood vessels. The pain may be related to migraine, muscular syndromes such as TMJ, herpetic or rheumatic disease or injury. Many sufferers have had sinus and dental surgeries in the past.

Trigeminal neuralgia is a common cause of facial pain characterized by shooting pains in the face, often triggered by touching affected areas.

Facial pain may be difficult to treat and usually requires trial and error with various medications. Perseverance by both the healthcare provider and the patient is necessary. The antidepressants and/or the anticonvulsants can be helpful in some cases.


Trigeminal Neuralgia (Tic Douloureux)

Trigeminal neuralgia (tic douloureux) generally strikes people over age 50. The head pain is unilateral, very intense, and recurrent, affecting the facial region. It is a sharp, burning type of pain, often set off by touch, chewing, laughing, talking, or even a cold breeze.

The pain is intermittent, with jabs lasting for approximately 30 seconds, followed by a few pain-free moments, and then another group of painful jabs, which may reoccur for a few hours at a time. The attacks can go on for weeks or months. Anticonvulsant medications may reduce the sensitivity in the facial region, thus preventing the attacks of pain. They may take effect anywhere from a few hours to a day after initiating treatment, and therapy should continue for weeks or months.

If medication is not effective, surgery may be indicated. Attacks may at times spontaneously subside.