Fierce facial pain from the slightest breeze after 40 — suspect “this”

 When jaw or facial pain occurs, most people think first of toothache or sinusitis. But for those aged 40 to 50 and above, the story is different. If sudden, extreme, electric-shock-like pain recurs from nothing more than everyday conversation or a light brush of wind, it is worth considering an abnormal nerve signal caused by ‘trigeminal neuralgia’.

Trigeminal neuralgia is a rare disease affecting roughly 4 to 7 people per 100,000. Patients aged 40 and over account for more than 90% of cases. Among patients, the increase has recently been even sharper in those aged 50 and over. As the population ages further, the number of trigeminal neuralgia patients is expected to grow still more.

In its early stages trigeminal neuralgia appears briefly and then disappears, so it is easy to dismiss. But left untreated, the attacks of pain grow more severe and the intervals shorter, which can greatly affect daily life. If such symptoms appear in middle age, it is important to watch the early signs closely and consult a specialist quickly.

Sudden, intense pain several times a day

Trigeminal neuralgia is pain caused by a disorder of the ‘fifth cranial nerve’ in the face. The fifth cranial nerve divides into three branches from its root, hence its name, the ‘trigeminal nerve’, and it governs facial sensation and the function of the masticatory muscles of the jaw. Trigeminal neuralgia is an idiopathic condition for which a specific cause is difficult to identify. In some patients, however, pain is known to arise when the nerve is compressed by a neighboring blood vessel or bony structure, or is damaged by infection or trauma.
Sudden, intense pain occurs. Abnormal symptoms such as spasms and paralysis also appear alternately. Symptoms can occur dozens of times a day, and their onset and cycle are hard to predict. This seriously disrupts daily life and markedly lowers quality of life.

Yoon, Kangjun, neurosurgery specialist and President of St. Peter's Hospital, said, “Trigeminal neuralgia can be triggered by light everyday contact such as washing the face or brushing the teeth, or even by talking or a change in air such as a breeze, causing strong, stabbing pain.” He added, “In severe cases, photophobia — pain brought on simply by exposure to bright light — has also been reported.”

The level of pain is also extremely high. On pain scales it can register up to 10 — worse than childbirth — and is described as resembling a severe electric shock. The pain comes on suddenly and vanishes in an instant, or lasts seconds or minutes before disappearing abruptly. Most trigeminal neuralgia is unilateral, affecting only one side of the face, though bilateral cases are occasionally reported.

Often mistaken for other conditions at first… if drug therapy does not work, ‘Microvascular Decompression (MVD)’

The key to treating trigeminal neuralgia is early diagnosis. Over time the pain grows stronger and the intervals between episodes shorter, raising the risk of it becoming chronic. It can also progress to nerve damage and muscle atrophy.

Because its symptoms resemble those of other conditions, the exact cause of trigeminal neuralgia often goes unidentified early on and the window for treatment is missed. It is easily confused with toothache, and some patients have a molar extracted at the dentist only for the pain to continue, leaving them anxious and suffering with no cause found. An accurate diagnosis requires differential diagnosis by a neurosurgery specialist.

Once trigeminal neuralgia is confirmed, treatment begins with conservative measures such as anticonvulsants and analgesics aimed at relieving the pain. If symptoms do not improve or the pain worsens despite long-term medication, microvascular decompression (MVD) is performed to address the underlying cause of the nerve damage.

Microvascular decompression (MVD) has been the mainstay treatment for trigeminal neuralgia, performed consistently for 30 years. It separates the blood vessel compressing the trigeminal nerve and inserts a Teflon cushion so that the pulsation of the vessel is not transmitted to the nerve. It is usually performed through a minimally invasive incision behind the ear, so scarring is minimal and recovery is quick.

Yoon, Kangjun, neurosurgery specialist and President of St. Peter's Hospital, said, “Patients with trigeminal neuralgia often mistake it early on for another condition such as toothache, sinusitis or a temporomandibular joint disorder and move from hospital to hospital.” He added, “To prevent misdiagnosis, it is important to assess the structural condition of the cranial nerves with tests such as MRI and CT in the early stage of the disease and then make a precise diagnosis.”