A jolt at the touch of a spring breeze…sudden facial pain after middle age should raise suspicion of ‘trigeminal neuralgia’
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Gangnam St. Peter's Hospital 26-04-06 09:01Main content
If a pain like electricity running through the face keeps recurring at even the brush of a spring breeze, it may not be a simple toothache or a temporomandibular joint problem. In particular, if sudden, intense facial pain appears from the age of 40 or 50 onward, it is worth suspecting ‘trigeminal neuralgia’. Even if the symptom passes quickly, leaving it untreated can make the pain progressively worse and shorten the intervals between attacks, seriously disrupting daily life, so early diagnosis is important.
Trigeminal neuralgia is a relatively rare condition, occurring in about four to seven people per 100,000, but more than 90% of patients are known to be aged 40 or over. The frequency tends to increase further after the age of 50, and analysts note that as the population ages the number of patients is likely to rise.
The condition arises from a disorder of the ‘trigeminal nerve’, the fifth cranial nerve, which is responsible for sensation in the face. The trigeminal nerve divides into three branches responsible for sensation around the face and jaw and for the function of the muscles of mastication; when this nerve is compressed or damaged by a blood vessel or surrounding tissue, excruciating pain can result. There are also a considerable number of idiopathic cases in which the exact cause has not been identified.
Its hallmark is intense pain that strikes without warning. Washing the face, brushing the teeth, talking, or even a light stimulus such as a passing breeze can trigger pain like an electric shock. The pain lasts from a few seconds to a few minutes and then disappears suddenly, and it may recur dozens of times a day. It is usually confined to one side of the face, although it appears on both sides in rare cases.
Director Yoon, Kangjun of the Department of Neurosurgery at St. Peter's Hospital explains, “Trigeminal neuralgia is characterized by excruciating pain triggered by everyday contact or even a change in the air,” adding, “In severe cases it can be accompanied by hypersensitivity to light.” The pain is so intense that it is sometimes described as worse than childbirth.
The problem is that it is often mistaken for another condition in the early stages. Because the symptoms resemble those of toothache, sinusitis or temporomandibular joint disorder, there are many cases in which patients receive dental treatment or even have a tooth extracted and the pain persists. For this reason, accurate differential diagnosis is more important than anything else.
Director Yoon stresses, “Patients with trigeminal neuralgia often go from hospital to hospital and end up being diagnosed late,” adding, “Imaging tests such as MRI or CT are needed to check the structure of the nerve and reach an accurate diagnosis.”
In the early stages, treatment attempts to relieve the pain with drug therapy using anticonvulsants and analgesics. However, if the drugs become less effective or the pain persists, surgical treatment to address the underlying cause is considered.
The representative surgical option, microvascular decompression (MVD), separates the blood vessel compressing the trigeminal nerve and inserts a cushion to block irritation of the nerve. Because it is performed through a minimal incision behind the ear, recovery is quick and the burden of scarring is small. Most patients can expect immediate pain relief together with long-term improvement.
The recent introduction of high-precision MRI, surgical microscopes and intraoperative nerve monitoring equipment has further raised the accuracy and success rate of the surgery. In actual clinical practice, symptom improvement is reported in more than 90% of cases, and for patients with a recurrence it is important to analyze the cause precisely and provide tailored treatment.
Specialists emphasize early diagnosis above all. If the pain recurs or gradually grows more intense, it should not be dismissed as ordinary pain; an accurate diagnosis from a neurosurgery specialist is needed. Improving lifestyle habits, including sufficient rest and stress management, can also help prevent symptoms from worsening.
Director Yoon advised, “Trigeminal neuralgia is a condition that can be managed well if it is detected early and treated appropriately,” adding, “If severe facial pain keeps recurring, you should see a specialist without delay.”
Trigeminal neuralgia is a relatively rare condition, occurring in about four to seven people per 100,000, but more than 90% of patients are known to be aged 40 or over. The frequency tends to increase further after the age of 50, and analysts note that as the population ages the number of patients is likely to rise.
The condition arises from a disorder of the ‘trigeminal nerve’, the fifth cranial nerve, which is responsible for sensation in the face. The trigeminal nerve divides into three branches responsible for sensation around the face and jaw and for the function of the muscles of mastication; when this nerve is compressed or damaged by a blood vessel or surrounding tissue, excruciating pain can result. There are also a considerable number of idiopathic cases in which the exact cause has not been identified.
Its hallmark is intense pain that strikes without warning. Washing the face, brushing the teeth, talking, or even a light stimulus such as a passing breeze can trigger pain like an electric shock. The pain lasts from a few seconds to a few minutes and then disappears suddenly, and it may recur dozens of times a day. It is usually confined to one side of the face, although it appears on both sides in rare cases.
Director Yoon, Kangjun of the Department of Neurosurgery at St. Peter's Hospital explains, “Trigeminal neuralgia is characterized by excruciating pain triggered by everyday contact or even a change in the air,” adding, “In severe cases it can be accompanied by hypersensitivity to light.” The pain is so intense that it is sometimes described as worse than childbirth.
The problem is that it is often mistaken for another condition in the early stages. Because the symptoms resemble those of toothache, sinusitis or temporomandibular joint disorder, there are many cases in which patients receive dental treatment or even have a tooth extracted and the pain persists. For this reason, accurate differential diagnosis is more important than anything else.
Director Yoon stresses, “Patients with trigeminal neuralgia often go from hospital to hospital and end up being diagnosed late,” adding, “Imaging tests such as MRI or CT are needed to check the structure of the nerve and reach an accurate diagnosis.”
In the early stages, treatment attempts to relieve the pain with drug therapy using anticonvulsants and analgesics. However, if the drugs become less effective or the pain persists, surgical treatment to address the underlying cause is considered.
The representative surgical option, microvascular decompression (MVD), separates the blood vessel compressing the trigeminal nerve and inserts a cushion to block irritation of the nerve. Because it is performed through a minimal incision behind the ear, recovery is quick and the burden of scarring is small. Most patients can expect immediate pain relief together with long-term improvement.
The recent introduction of high-precision MRI, surgical microscopes and intraoperative nerve monitoring equipment has further raised the accuracy and success rate of the surgery. In actual clinical practice, symptom improvement is reported in more than 90% of cases, and for patients with a recurrence it is important to analyze the cause precisely and provide tailored treatment.
Specialists emphasize early diagnosis above all. If the pain recurs or gradually grows more intense, it should not be dismissed as ordinary pain; an accurate diagnosis from a neurosurgery specialist is needed. Improving lifestyle habits, including sufficient rest and stress management, can also help prevent symptoms from worsening.
Director Yoon advised, “Trigeminal neuralgia is a condition that can be managed well if it is detected early and treated appropriately,” adding, “If severe facial pain keeps recurring, you should see a specialist without delay.”