Do you know that Salman Khan has publicly spoken about his battle with trigeminal neuralgia? This a rare nerve condition resulting in abrupt, intense pain that is sharp and localised to one side of the face. A shooting, electric shock-like pain in the teeth, jaw, gums, and other places is how people describe it. It is often known as the most excruciating pain known to humanity. To know more about this condition, we spoke to Dr Mohan Krishna J, Consultant Neurologist, Yashoda Hospitals, Hyderabad.
What Causes Trigeminal Neuralgia?
Dr Krishna said, "The trigeminal nerve, which originates at the ear and extends to the forehead, cheeks, and lower jaw, is what causes trigeminal neuralgia." He added that pain from this illness typically affects only one side of the face and can be brought on by activities, such as eating or tooth cleaning.
It impacts the trigeminal nerve, which is the fifth cranial nerve. This nerve has three divisions, namely the ophthalmic, maxillary, and mandibular branches. "These branches transmit sensations like temperature, touch, and pain from the forehead, cheek, and lower jaw to the brain. Every person has a pair of trigeminal nerves that supply one-half of the face," added the doctor. "Typically, trigeminal neuralgia affects one branch of the trigeminal nerve, but in rare cases, it can also affect two or all three branches," he stated.
According to a research published on the National Center for Biotechnology Information portal, trigeminal neuralgia affects 4 to 13 people per 100000 people per year. "It affects women more frequently than men. Most patients are above 50 years of age and affects children very rarely. It can also affect young adults but underlying causes like multiple sclerosis should be ruled out," added Dr Krishna.
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Characteristics Of Trigeminal Neuralgia
According to Dr Krishna, trigeminal Neuralgia is characterised by the following:
- Episodes of electric shock-like pains lasting for a fraction of a second to about two minutes affecting one side of the face.
- People may also experience stabbing or lightning bolt-like pains, which are often triggered by innocuous activities like shaving, brushing teeth, cold exposure, or even talking.
- Pains are often severe in intensity occurring multiple times throughout the day causing significant disability to patients. They are associated with facial spasms occasionally which is called by French physician Nicolaus Andre as “tic douloureux”.
Pain episodes rarely occur in sleep but they can cause social withdrawal and depression due to fear of attacks.
Classification of Trigeminal Neuralgia
This condition is classified according to the symptoms of the patient as
- Type 1: Presence of paroxysmal pain (pain that comes on suddenly and lasts for a short time) alone.
- Type 2: Paroxysmal pain with persistent pain in the background.
According to the International Classification of Headache Disorders-3 (ICHD-3), trigeminal neuralgia has three subtypes depending on the cause.
- Classic trigeminal neuralgia: This is the most common type that occurs due to compression of the nerve by a blood vessel most commonly the superior cerebellar artery at the origin of the nerve.
- Secondary trigeminal neuralgia: This is the least common type that occurs due to underlying diseases like multiple sclerosis, arteriovenous malformations, and cerebellopontine angle tumours.
- Idiopathic trigeminal neuralgia: In this condition the cause is unknown and a brain scan i.e. Magnetic Resonance Imaging (MRI) does not show any abnormality.
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Treatment Of Trigeminal Neuralgia
Dr Krishna said, "The treatment of trigeminal neuralgia depends on the cause, patient's disability, and preferences." Treatment options include medical and surgical methods. Explaining the details, the doctor said, "The use of anti-epileptics is the most common type of treatment method. Additionally, surgical options, such as radiofrequency ablation or microvascular decompression."
Trigeminal neuralgia affects each patient differently with varying frequency and severity. Dr Krishna said, "Although trigeminal neuralgia is not a life-threatening situation, it can lead to lifelong pain and disability with significant psychological effects on patients and their families. Hence treatment should be individualised after discussing the benefits and risks of treatment."
He added that managing a patient with trigeminal neuralgia often involves a multidisciplinary team of experts like neuro-physicians, neurosurgeons, and anaesthetists." Prompt and correct diagnosis of trigeminal neuralgia and its underlying cause can significantly reduce the disability burden of patients making their lives better and pain-free.
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