What is Trigeminal Neuralgia (Facial Pain)?
The most common cause of facial pain is trigeminal neuralgia. It is a form of chronic pain that can disrupt daily activities due to its unpredictable and agonising nature.
Common triggers for this condition include daily activities such as talking, brushing teeth, eating, or applying make-up.
What are the Symptoms of Trigeminal Neuralgia (Facial Pain)?
Pain arises from the trigeminal nerve (fifth cranial nerve) and manifests as sharp, shooting pain lasting for a few seconds to minutes. It typically occurs in one side of the face, often around the cheek, jaw, or lower part of the face. The episodes can occur several times a day, and in some cases, the pain can become constant. The intensity and frequency of the pain can be debilitating, severely impacting the quality of life.
Symptoms to Watch For:
- Sharp or stabbing facial pain
- Pain localised to one side of the face
- Pain triggered by touch or everyday activities like eating or speaking
- Intense bursts of pain lasting a few seconds to minutes
- Pain radiating from the cheek, jaw, or lower face
When to See a Doctor:
- If the pain is affecting your quality of life
- If the episodes of pain become more frequent or intense
- If over-the-counter pain medications are not providing relief
- If the symptoms are causing you distress or are affecting your ability to eat, speak, or perform daily activities
What Causes Trigeminal Neuralgia (Facial Pain)?
In many cases, trigeminal neuralgia is caused by pressure on the nerve. This can happen due to a blood vessel pressing against the trigeminal nerve as it exits the brain stem, causing it to malfunction. Ageing and certain diseases like multiple sclerosis, which damage the myelin sheath protecting the nerves, can also cause trigeminal neuralgia, hence treatment is often sought to manage the condition.
Types of Trigeminal Neuralgia (Facial Pain) Treatment
Diagnosis and Evaluation
Diagnosis of trigeminal neuralgia involves clinical evaluation, including a detailed patient history and physical examination. An MRI scan may be necessary to rule out possible compression of the trigeminal nerve by a blood vessel or, rarely, a tumour. Should this occur, a referral to a neurosurgeon is essential for further evaluation and possible surgical intervention.
For primary trigeminal neuralgia – where there is no identifiable cause for the pain – first-line treatment options often include medications such as carbamazepine, gabapentin, or pregabalin. These medications work by slowing down nerve signals, effectively reducing the speed at which pain messages are sent to the brain. Other medications like muscle relaxants or certain antidepressants may also be considered depending on the specific case.
Radiofrequency (RF) Ablation
When medication therapy fails to provide sufficient relief or produces intolerable side effects, Radiofrequency Ablation can be an option. This is a minimally invasive treatment that uses high frequency waves to produce heat, which is then used to damage specific nerves and interrupt their ability to transmit pain signals to the brain. A special RF needle is inserted into the trigeminal ganglion, the main part of the nerve that is causing the pain.
RF energy is then generated through a machine to create heat. This heat is transmitted through the needle tip to destroy the painful division of the trigeminal nerve. This is a day surgery procedure that is performed using CT scan guidance under mild sedation. It is a safe and efficient method that can effectively reduce facial pain in more than 90% of patients. Patients can usually return home the same day of the procedure.
Gamma Knife Radiosurgery
Another option for those who are not responding well to medications is Gamma Knife Radiosurgery. This treatment uses focused radiation beams to target the trigeminal nerve, disrupting the transmission of pain signals without the need for an incision.
Microvascular Decompression is a surgical procedure that involves relocating or removing blood vessels that are in contact with the trigeminal root. This alleviates the pressure that is causing the nerve to malfunction and transmit pain signals.
Each of these treatment options has its own set of risks and benefits, which should be thoroughly discussed with your pain medicine physician to determine the most appropriate treatment for you.
Schedule a Consultation Today
Don’t let the agony and distress of trigeminal neuralgia confine your life within its limits. Schedule a consultation with our seasoned specialists at The Pain Clinic to explore how our treatments, such as medication management and Radiofrequency Ablation, can offer the relief you’ve been longing for.
We’re committed to helping you reclaim your daily routine, reduce your facial pain, and restore your overall quality of life. Our dedicated team in Singapore will work closely with you to create a personalised treatment plan that is tailored to your needs.
Meet Our Doctor
Dr Ho Kok Yuen is a specialist in pain medicine and anaesthesia. He completed his pain management fellowship at Duke University Hospital in USA in 2006. He is involved in teaching, research and also serves on numerous advisory boards. Besides writing articles in peer-reviewed journals, clinical practice and consensus guidelines, as well as book chapters on pain and anaesthesia, he lectures at international conferences and teaches at interventional pain workshops frequently.
Dr Ho Kok Yuen obtained his MBBS and Master of Medicine (Anaesthesiology) from the National University of Singapore. He holds a Graduate Diploma in Sports Medicine (GDSM) from the Lee Kong Chian School of Medicine (LKCMed) at Nanyang Technological University.
- Diplomate, American Academy of Pain Management (DAAPM)
- European Diploma in Pain Medicine (EDPM), European Society of Regional Anaesthesia (ESRA)
- European Diploma in Pain Medicine (EDPM), European Pain Federation EFIC
- Graduate Diploma in Sports Medicine, Lee Kong Chian School of Medicine (LKCMed)
- Chairman, Chapter of Pain Medicine Physicians, Academy of Medicine, Singapore
- Council Member, College of Anaesthesiologists, Academy of Medicine, Singapore
- Chairman, South-East Asian Section, World Institute of Pain (WIP)
- Fellow, Interventional Pain Practice (FIPP) with the WIP
- Examiner, FIPP Examinations
- Fellow, Academy of Medicine, Singapore (FAMS)
- Past President, The Pain Association of Singapore (2011-2017)
- Past Vice-President, Association for South-East Asian Pain Societies (ASEAPS) (2012-2013)
Dr Ho Kok Yuen is widely recognised as an expert in minimally invasive interventional pain management, having performed thousands of such surgeries. He treats persistent and severe pain using therapies such as steroid injections, nerve blocks, radiofrequency ablation, intrathecal drug delivery and spinal cord stimulation.
The first physician in Asia to perform cooled radiofrequency ablation, he has been treating spine, sacroiliac joint, hip, and knee pain using this technique since 2006. He also administers spinal infusions to ensure pain-free end-of-life comfort care for patients with advanced terminal cancer pain.
When Boston Scientific launched its most advanced SCS system – the WaveWriter Alpha™ – in Southeast Asia, Dr Ho Kok Yuen was the first doctor to perform the implant surgery. SCS uses electrical impulses to block pain signals in the spinal cord, effectively treating intractable back pain, leg pain and neuropathic pain. SCS therapy has helped hundreds and thousands of people around the world improve their quality of life.
Frequently Asked Question About Trigeminal Neuralgia
Facial pain, particularly that associated with trigeminal neuralgia, is most commonly caused by a malfunction in the trigeminal nerve, which is the primary nerve responsible for sensations in the face. While the exact cause may vary, often it can be attributed to a blood vessel pressing against the nerve, leading to severe, sharp facial pain. Rarely, other causes such as a tumour or nerve damage due to disease can also contribute to facial pain. Treatment is often sought for this condition.
Trigeminal neuralgia presents with several characteristic symptoms. The most prominent one is a sudden, severe, sharp or stabbing facial pain. The pain often occurs in bouts and may be triggered by everyday activities like talking, eating, brushing teeth, or even a gentle breeze. The attacks may last from a few seconds to a few minutes, and they can occur repeatedly throughout the day. In some cases, patients may also experience a burning sensation or numbness in the face. Treatment is usually required to combat the intense discomfort associated with this condition.
Treatment for trigeminal neuralgia aims to relieve the symptoms and manage the pain. The standard first-line treatment is medication management, including drugs such as carbamazepine, gabapentin, or pregabalin. These medications help in reducing the nerve’s response, thus relieving pain.
However, if medication fails to provide relief or causes significant side effects, other treatments such as Radiofrequency Ablation may be considered. This treatment involves inserting a special needle into the trigeminal ganglion and using radiofrequency energy to create heat, which destroys the painful division of the trigeminal nerve.
For cases where trigeminal neuralgia is caused by a blood vessel or tumour pressing on the nerve, referral to a neurosurgeon is needed. They may recommend surgical intervention to remove the pressure on the nerve. The choice of treatment depends on the individual’s health, severity of symptoms, and their response to medication. Always consult with a specialist for the best-suited treatment for your condition.