"Trigeminal neuralgia upends daily life in your 40s and 50s… early diagnosis determines the outcome"
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Gangnam St. Peter's Hospital 26-04-07 11:01Main content
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, with patients aged 40 and over accounting for more than 90% of cases. The increase is known to be even sharper among those aged 50 and over. As the population ages, the number of trigeminal neuralgia patients in Korea is likely to rise further.
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 above all important to watch the early signs closely and consult a specialist quickly.
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.
Its most notable feature is sudden, intense pain. 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, explains, “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 adds, “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.
The key to treating trigeminal neuralgia is early diagnosis. Over time the pain tends to grow stronger and the intervals between episodes shorter, raising the risk of it becoming chronic, and there is also concern about nerve damage and progressive muscle atrophy.
Trigeminal neuralgia has symptoms similar to those of other conditions, so it is not uncommon for the exact cause to go unidentified early on and for the window for treatment to be missed. It is easily confused with toothache, and there are cases in which patients continue to have pain even after a molar has been extracted at a dental clinic and report anxiety and suffering without the cause being found. An accurate diagnosis requires a differential diagnosis by a neurosurgery specialist.
Yoon, Kangjun, neurosurgery specialist and President of St. Peter's Hospital, explains, “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 adds, “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.”
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. Most patients see immediate improvement in symptoms and a semi-permanent treatment effect.
Surgical outcomes have improved further with the use of advanced equipment and techniques, including precise MRI imaging, a surgical microscope combined with angiography, and intraoperative neuromonitoring, and success rates are high. Using a Gore-Tex band and brain gel to separate and secure the nerve and the cerebral vessels more firmly helps improve surgical results still further. At St. Peter’s Hospital, in fact, microvascular decompression has produced a cure in more than 95% of patients with trigeminal neuralgia and other facial nerve disorders.
A growing number of patients also come to the hospital after being treated at another institution only for the pain to return. In such cases it is important to examine closely both the cause of the recurrence and the current state of the nerve before drawing up a treatment plan suited to that condition.
The exact cause of trigeminal neuralgia is unknown, though in some cases it is associated with high physical or mental stress, fatigue or tension. Getting enough rest, keeping regular habits, and reducing exposure to highly stressful environments can therefore also help manage symptoms.
Dr. Yoon, Kangjun said, "If severe facial pain recurs or worsens, seeing an experienced neurosurgery specialist early is more important than anything," adding, "If you receive an accurate diagnosis of trigeminal neuralgia and a systematic treatment plan is drawn up by a medical team capable of performing highly complex microvascular decompression, a good prognosis can be expected."
Trigeminal neuralgia is a rare disease affecting roughly 4 to 7 people per 100,000, with patients aged 40 and over accounting for more than 90% of cases. The increase is known to be even sharper among those aged 50 and over. As the population ages, the number of trigeminal neuralgia patients in Korea is likely to rise further.
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 above all important to watch the early signs closely and consult a specialist quickly.
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.
Its most notable feature is sudden, intense pain. 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, explains, “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 adds, “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.
The key to treating trigeminal neuralgia is early diagnosis. Over time the pain tends to grow stronger and the intervals between episodes shorter, raising the risk of it becoming chronic, and there is also concern about nerve damage and progressive muscle atrophy.
Trigeminal neuralgia has symptoms similar to those of other conditions, so it is not uncommon for the exact cause to go unidentified early on and for the window for treatment to be missed. It is easily confused with toothache, and there are cases in which patients continue to have pain even after a molar has been extracted at a dental clinic and report anxiety and suffering without the cause being found. An accurate diagnosis requires a differential diagnosis by a neurosurgery specialist.
Yoon, Kangjun, neurosurgery specialist and President of St. Peter's Hospital, explains, “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 adds, “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.”
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. Most patients see immediate improvement in symptoms and a semi-permanent treatment effect.
Surgical outcomes have improved further with the use of advanced equipment and techniques, including precise MRI imaging, a surgical microscope combined with angiography, and intraoperative neuromonitoring, and success rates are high. Using a Gore-Tex band and brain gel to separate and secure the nerve and the cerebral vessels more firmly helps improve surgical results still further. At St. Peter’s Hospital, in fact, microvascular decompression has produced a cure in more than 95% of patients with trigeminal neuralgia and other facial nerve disorders.
A growing number of patients also come to the hospital after being treated at another institution only for the pain to return. In such cases it is important to examine closely both the cause of the recurrence and the current state of the nerve before drawing up a treatment plan suited to that condition.
The exact cause of trigeminal neuralgia is unknown, though in some cases it is associated with high physical or mental stress, fatigue or tension. Getting enough rest, keeping regular habits, and reducing exposure to highly stressful environments can therefore also help manage symptoms.
Dr. Yoon, Kangjun said, "If severe facial pain recurs or worsens, seeing an experienced neurosurgery specialist early is more important than anything," adding, "If you receive an accurate diagnosis of trigeminal neuralgia and a systematic treatment plan is drawn up by a medical team capable of performing highly complex microvascular decompression, a good prognosis can be expected."