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.
Medication Treatments
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, 射频消融术 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
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.
何国元医生在新加坡国立大学获得了医学学士学位和医学硕士学位（麻醉学）。他持有南洋理工大学李光前医学院（LKCMed）的运动医学研究生文凭（GDSM）。
Education
- 美国疼痛管理学院（DAAPM）院士
- 欧洲局部麻醉与疼痛医学学会（ESRA）欧洲疼痛医学文凭（EDPM）
- 欧洲疼痛联盟（EFIC）欧洲疼痛医学文凭（EDPM）
- 李光前医学院体育医学研究生文凭（LKCMed）
Credentials
- Chairman, Chapter of Pain Medicine Physicians, Academy of Medicine, Singapore
- Council Member, College of Anaesthesiologists, Academy of Medicine, Singapore
- 世界疼痛学院（WIP）东南亚分会主席
- 世界疼痛学院介入性疼痛治疗院士（FIPP）
- FIPP考试考官
- 新加坡医学院院士（FAMS）
- 新加坡疼痛协会前任会长（2011-2017）
- 东南亚疼痛协会（ASEAPS）前任副会长（2012-2013）
Area of Expertise
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.
当波士顿科学公司(Boston Scientific) 在东南亚推出其最先进的脊髓刺激系统 WaveWriter Alpha™ 时，何国元医生是东南亚第一位为病患做植入手术的医生。SCS使用电脉冲来阻止脊髓中的疼痛信号，有效地治疗难治性背痛、腿痛和神经痛。脊髓刺激疗法已经帮助全世界数以千计的人，改善了他们的生活质量。
Frequently Asked Question About Trigeminal Neuralgia
1. What causes facial pain?
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.
2. What are the common symptoms of trigeminal neuralgia?
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.
3. What is the treatment for trigeminal neuralgia?
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.