Agony even from a passing spring breeze…‘trigeminal neuralgia’ disrupts life in the prime of middle age

 An extremely intense pain strikes the face out of nowhere in the middle of daily life. You might assume it is toothache from a cavity you had not noticed, but for middle-aged and older people the story is different — it may be ‘trigeminal neuralgia’, an abnormal signal from the facial nerves.

The face has three branches of sensory nerve (the fifth cranial nerve) running to the forehead, cheek and jaw. Trigeminal neuralgia is the pain that arises when these three nerves are compressed by neighboring blood vessels or bony structures, or damaged by infection or trauma. It occurs in about 4.5 people per 100,000, with patients aged 40 and over accounting for more than 90% of cases. The increase is known to be especially marked in women aged 50 and over.

Above all, trigeminal neuralgia strikes during everyday actions such as talking, washing the face or brushing the teeth, lowering quality of life. Pain can also be brought on by nothing more than a change in the air, such as a breeze, so it may be felt at times like now, when chilly spring winds blow morning and evening.

The pain is severe enough that patients describe it as ‘like a bolt of lightning’. It is clearly different from toothache, however.

Kwon Kyung-hyun, Chief of Neurology at Saeran Hospital, explained, “Toothache lasts all day and, depending on where it hurts, can make the whole face throb, whereas trigeminal neuralgia comes as a momentary burst of strong pain on just one side of the face within two to three seconds and disappears within two minutes at most.” He added, “Sensation is preserved, so other neurological symptoms such as numbness do not appear.”

An MRI scan is essential for an accurate diagnosis, however. The compression of blood vessels around the nerve that occurs in most cases of trigeminal neuralgia can be confirmed on MRI images, which also allow it to be clearly distinguished from other conditions that are easily mistaken for it.

An early, accurate diagnosis is also very important for what follows. Yoon, Kangjun, President of St. Peter's Hospital and a neurosurgery specialist, stressed the importance of early treatment: “With trigeminal neuralgia, the pain grows more intense over time and the intervals between episodes shorten, so it can become chronic, and above all nerve damage and muscle atrophy can progress.”

Once trigeminal neuralgia is diagnosed, the pain is first relieved with conservative treatment such as anticonvulsants and analgesics. If symptoms do not improve or the pain worsens despite long-term treatment, surgery should be considered to address the cause of the nerve damage.

The main option is microvascular decompression (MVD), which separates the blood vessel compressing the trigeminal nerve and inserts a Teflon cushion. This prevents the pulsation of the vessel from being transmitted to the nerve, and because the operation is performed through a small incision behind the ear, scarring is minimal and recovery is quick.

Lifestyle management should go hand in hand with treatment. Although no clear cause has been identified, heavy stress, fatigue and tension are known to affect symptoms, so sufficient rest, regular daily habits and efforts to minimize stress are needed.