Severe facial pain that strikes without warning… raising the odds of treating trigeminal neuralgia

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Sudden, severe pain striking the face…

Trigeminal neuralgia, striking like an electric shock, can be cured

- Severe pain can strike without warning during brushing, eating and other daily activities, dozens of times a day

- Microvascular Decompression (MVD) treats the root cause of trigeminal neuralgia for a complete cure

“It felt like an electric shock to my face while I was brushing my teeth,” says Kwon Hee-jung (48, a resident of Dogok-dong, Seoul). Ms. Kwon repeatedly felt a sharp, tingling pain on one side of her face. Having transferred to a new department at work, she dismissed it as ‘severe stress’ from adjusting to new duties. Suspecting a cavity, she visited a dental clinic, but her teeth were found to be normal. When the intense, electric-shock-like pain kept recurring, Ms. Kwon urgently visited a neurosurgery clinic, where she received a diagnosis she had never even heard of: trigeminal neuralgia. 

Twelve nerves run through the human brain. The fifth cranial nerve is responsible for sensation in the face and for the muscles of mastication. It is called the trigeminal nerve because the root of its sensory nerve divides into three branches. When something goes wrong with the trigeminal nerve, extreme pain follows. Symptoms tend to worsen from this time of year as the weather turns colder. 

An analysis of 8,582 patients who first visited St. Peter’s Hospital for trigeminal neuralgia (diagnostic codes G500 + G513) between 2016 and 2019 found that 68.3% (5,860) were women and 31.7% (2,722) were men. By age group, patients in their 50s accounted for 34.2% (2,937), those in their 60s for 28.5% (2,443), and those in their 40s for 18.1% (1,556), showing that the condition occurs commonly in women from middle age onward. 

Yoon, Kangjun, President of St. Peter's Hospital and a neurosurgery specialist, said, “In people with trigeminal neuralgia the nerve itself is normal. A blood vessel runs beside the nerve, and where the two press closely together the nerve is irritated as if short-circuited, producing severe pain.” 

Trigeminal neuralgia causes sharp, violent, electric-shock-like pain around the forehead, cheek, teeth and jaw at regular intervals. Because it is mistaken early on for a headache or toothache, patients may take painkillers indiscriminately or insist on having a tooth extracted at the dentist. 

“It suddenly felt like an electric shock hit my face.” “It feels like my whole face is being stabbed with a knife.” Patients use frightening expressions like these because the pain of trigeminal neuralgia is so extreme. This sharp pain can last from a few seconds to a few minutes, and once it starts it may recur all night long, making sleep impossible. 

Symptoms may not end within a day — very severe pain can persist for a week or even two — or they may occur dozens of times a day. The pain strikes without warning at unexpected moments during daily routines, such as brushing the teeth or eating. Because there is no way to know when or where symptoms will appear, and because the pain is so intense, patients not only struggle in daily life but may also develop social avoidance and increasing depression. 

Early treatment matters most in trigeminal neuralgia. Because nerve damage progresses steadily, muscle atrophy sets in and eating becomes difficult, leading to nutritional deficiency. Pain also heightens emotional sensitivity, making social life difficult. If symptoms of trigeminal neuralgia appear, it is best to receive appropriate treatment early. 

Treatment for trigeminal neuralgia begins with drug therapy using analgesics or anticonvulsants that relieve nerve pain. When the condition recurs frequently or worsens despite drug therapy, the surgical option of microvascular decompression (MVD) may be considered. In MVD, a 4-5 cm incision is made behind the ear and a medical Teflon pad is inserted at the blood vessel compressing the nerve, separating the vessel from the nerve. The cure rate is over 90%. 

“Surgical techniques for trigeminal neuralgia have advanced, and because treatment follows confirmation with precise MRI, the surgical prognosis is quite good,” says Yoon, Kangjun, neurosurgery specialist and President of St. Peter’s Hospital. “Hemifacial spasm and trigeminal neuralgia can be cured by resolving the underlying cause with microvascular decompression (MVD), which separates the cranial nerve from the blood vessel. I hope patients will consult a neurosurgery specialist with extensive surgical experience and free themselves from the suffering of trigeminal neuralgia,” he added, urging patients not to give up on treatment.