A pain in the face can be explained by various causes, such as a blow, infections caused by sinusitis, a dental abscess and dysfunctions in the temporomandibular joint.
It can also be caused by trigeminal neuralgia, a condition that comes from contact between an artery or vein and the nerve located at the base of the brain called the trigeminal nerve.
This type of neuralgia is often associated with aging, multiple sclerosis, a disorder that damages the myelin sheath that protects certain nerves, a surgical injury, or facial trauma.
The pain, which can be sudden and very intense, can be manifested by very mild stimulations, such as when the person eats, drinks, talks, smiles, washes their face, shaves or puts on makeup, brushes their teeth, washed their face and even when feeling a breeze.
Symptoms
Trigeminal neuralgia is a progressive condition that can cause increasingly acute, prolonged and frequent episodes of pain. Let’s look at the symptoms:
- Severe spontaneous, stabbing or sharp pain, similar to an electric shock.
- Isolated episodes of pain that last for periods of seconds or minutes, up to multiple interrupted attacks that last from days to months.
- A constant aching or burning sensation prior to an episode of spasmodic pain, in the cheek, jaw, teeth, gums, lips, eyes, or forehead.
- Pain on only one side of the face or pain that is focused in one place or spreading to a larger area.
Treatment
To diagnose if the pain in the face is the cause of trigeminal neuralgia and, if positive, determine the type, location and triggers, neurosurgeons perform a neurological examination and order a brain MRI.
If we verify that we are facing trigeminal neuralgia, we prescribe a treatment with medications, which can be anticonvulsants, spasmolytics or botox injections, in order to reduce or eliminate the pain signals that are sent to the brain.
But in extreme cases, when the drugs do not work or cause the patient side effects, we resort to some surgical procedure, such as:
- Microvascular decompression, which consists of relocating or eliminating blood vessels that are in contact with the trigeminal nerve root, in order to stop the nerve from malfunctioning.
We can also use other procedures, such as rhizotomy, through which we destroy nerve fibers to reduce pain. There are three types of rhizotomy:
- Glycerol injection, which involves bringing a needle through the face and through an opening at the base of the skull to the trigeminal cistern, to inject a small amount of sterile glycerol that damages the trigeminal nerve and blocks pain signals .
- Balloon compression, which allows us to insert a hollow needle through the face and base of the skull, to thread a balloon catheter. We inflate the balloon to damage the trigeminal nerve and block pain signals.
- Radiofrequency thermal injuries, which also consists of carrying a hollow needle to a part of the trigeminal nerve, to insert an electrode and send a mild electrical current, in order to destroy the nerve fibers associated with pain.
It must be borne in mind that in all types of treatment for trigeminal neuralgia, from medications to surgery and rhizotomy, there are risks and side effects that we must discuss with the patient.
In any case, if you experience pain in your face that is not relieved by over-the-counter pain relievers, particularly if it is prolonged or recurrent, do not hesitate to contact me.
