Everyday actions such as chewing, shaving or washing the face can set off an attack.
You sip some water, brush your teeth or wash your face – and a bolt of pain shoots through your cheek or jaw. You might blame a bad tooth. But if the dentist finds nothing wrong and the pain keeps returning in sharp bursts, a nerve disorder may be to blame.
Trigeminal neuralgia causes brief, electric shock-like pain on one side of the face. Attacks can last from just a few seconds to two minutes, but can be severe enough to make eating, drinking and talking difficult, says Mount Alvernia Hospital neurologist Queck Kian Kheng. Here, he shares more about the condition and treatments.
Q: What causes trigeminal neuralgia, and why can it feel like a toothache?
The condition affects the trigeminal nerve, which carries sensation from the face to the brain. Sometimes, a blood vessel presses against the nerve and irritates it. In other cases, no clear cause is found. More rarely, the nerve may be compressed by a tumour.
The pain often strikes the cheek, upper or lower jaw – the same areas where tooth or gum pain is felt – so many patients tend to first seek help from a dentist. It may also travel to the lips or chin.
These same areas can also be extremely sensitive to touch. Even light contact with the face or inside the mouth may trigger an attack. This is why patients will dread even ordinary activities such as talking, chewing, teeth brushing, face washing or shaving as they become painful during a flare-up.
Q: How do doctors diagnose trigeminal neuralgia and rule out other causes?
Doctors rely on a detailed account of the patient’s pain and a physical examination. They will want to know where it hurts, how long each attack lasts and what brings it on. A dental assessment may sometimes be needed, especially if symptoms persist despite medication, or the cause is unclear. An MRI scan of the brain may also be done to look for an underlying cause.
Q: How is it treated and what helps during flare-ups?
Doctors typically prescribe medications to keep attacks under control. Because certain genetic variants are linked to a higher risk of rare but serious skin reactions, some patients may require a genetic test before starting some medicines. The medication can be adjusted if needed.
Taking extra care around known trigger points – for example, when brushing the teeth, washing the face, chewing or applying make-up – may help reduce attacks.
During a severe flare-up, when the pain can make it too hard to eat or drink, the patient may need hospital care for hydration, nutrition and short-term pain relief. Local anaesthetic treatments or fast-acting medicines may sometimes be used to ease the worst episodes.
If medication does not give enough relief or causes bothersome side effects, surgery may be an option, especially when a blood vessel is found to be pressing on the nerve.
Dr Queck Kian Kheng
Neurologist
KK Queck Neurology Centre
Medical Centre A #02-01A
Mount Alvernia Hospital
Source: The Straits Times © SPH Media Limited. Permission required for reproduction.