Sudden facial pain: early diagnosis of trigeminal neuralgia matters in your 40s and 50s

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If even a spring breeze brings stabbing facial pain, see a neurosurgeon

‘Trigeminal neuralgia’ that suddenly upends daily life in your 40s–50s…

Early diagnosis decides the prognosis

- Over 90% of trigeminal neuralgia patients are 40 or older… see a specialist promptly if severe facial pain recurs

- A light touch or even a breeze can trigger sudden, severe pain… lasting from seconds to minutes

- Accurate differential diagnosis from toothache, TMJ disorder and other conditions is essential… Microvascular Decompression (MVD) gives immediate, permanent relief

▲ This image was created using AI image generation.

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.

■ Marked by sudden, intense pain caused by a disorder of the fifth cranial nerve… often called worse than childbirth

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.

▲ This image was created using AI image generation.

■ Frequently mistaken for other conditions at first… when conservative care fails, Microvascular Decompression (MVD) separates the nerve from the vessel

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.

Because its symptoms resemble those of other conditions, trigeminal neuralgia is often not identified correctly at first, and the window for treatment is missed. It is easily confused with a toothache, and there are cases in which pain persists even after a molar has been extracted at a dental clinic, leaving patients anxious and in pain with no explanation. Differential diagnosis by a neurosurgery specialist is essential for an accurate diagnosis. 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 a toothache, sinusitis or a temporomandibular joint disorder, and go from hospital to hospital.” He adds, “To prevent misdiagnosis, it is important to assess the structural condition of the cranial nerves with examinations such as MRI and CT early in the disease, and then reach 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, 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 pain returns following treatment elsewhere; in such cases it is important to examine the cause of the recurrence and the current state of the nerve closely, and then establish 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.

Yoon, Kangjun, neurosurgery specialist and Director at St. Peter's Hospital, said, “When severe facial pain keeps recurring or worsens, the most important thing is to see an experienced neurosurgery specialist early.” He added, “With a physician who can make an accurate diagnosis of trigeminal neuralgia and perform demanding microvascular decompression, a systematic treatment plan can lead to a good prognosis.”