Hyderabad: Trigeminal neuralgia is a neurological condition marked by sudden, severe facial pain that can interfere with basic daily activities such as eating, talking and brushing teeth. Though relatively uncommon, specialists say the condition is often misdiagnosed, leading to delays in treatment.
Explaining the disorder, Dr. Y. Muralidhar Reddy, Senior Consultant and Head of Neurology at Renova Century Hospitals, Banjara Hills, said trigeminal neuralgia affects the trigeminal nerve, the fifth cranial nerve responsible for sensation in the face.
“Trigeminal neuralgia is a disease of the trigeminal nerve, which supplies sensation to the head and face. It is a form of neuropathic pain that occurs due to damage or compression of the nerve fibres,” Dr. Reddy said.
Early symptoms often overlooked
The most common symptom is sudden, intense pain on one side of the face, often described as electric shock–like or stabbing in nature. According to Dr. Reddy, the pain can occur in short bursts, known as paroxysms, or persist continuously in some patients.
“The pain is commonly triggered by routine activities such as shaving, washing the face, eating, drinking, brushing teeth, talking or even exposure to a light breeze,” he said.
Many patients mistake the pain for a dental problem and seek dental treatment initially, delaying neurological evaluation.
“It is frequently confused with toothache, migraine or cluster headaches, which contributes to delayed diagnosis,” Dr. Reddy added.
Causes and risk factors
Trigeminal neuralgia can have multiple underlying causes. The most common form occurs due to compression of the trigeminal nerve by a blood vessel, usually the superior cerebellar artery.
“Secondary trigeminal neuralgia can result from conditions such as multiple sclerosis, tumours or arteriovenous malformations. In some cases, no cause is identified, and the condition is termed idiopathic,” Dr. Reddy explained.
Risk factors include increasing age, female gender, uncontrolled blood pressure and smoking, he noted.
How the condition Is diagnosed
Diagnosis is primarily based on clinical symptoms, with imaging used to identify the underlying cause.
“Trigeminal neuralgia is a clinical diagnosis. MRI scans of the brain help detect causes such as demyelinating plaques in multiple sclerosis, tumours like schwannomas, or neurovascular compression,” Dr. Reddy said.
Treatment options available
Medication is typically the first line of treatment. Anti-seizure drugs form the backbone of medical therapy.
“Commonly used medications include carbamazepine, oxcarbazepine, gabapentin and pregabalin, along with sodium channel blockers such as lamotrigine, lacosamide, topiramate and phenytoin,” Dr. Reddy said.
If medications fail to control symptoms or lose effectiveness over time, surgical options may be considered.
“Surgical treatments include rhizotomy, radiosurgery, microvascular decompression and peripheral neurectomy, including local alcohol injections,” he added.
Managing daily triggers
Patients are advised to identify and minimise exposure to triggers that provoke pain episodes.
“Lifestyle adjustments such as consuming soft, lukewarm foods, protecting the face from cold air and wind, and modifying oral hygiene routines can help reduce nerve stimulation,” Dr. Reddy said.
Long-Term outlook and quality of life
The course of trigeminal neuralgia varies widely among patients.
“Some individuals experience episodes lasting weeks or months followed by pain-free periods, while others have continuous background pain with intermittent attacks. In a few cases, the condition worsens over time,” Dr. Reddy said.
He added that medications may become less effective in the long term, making regular follow-up essential.
Early diagnosis and timely intervention, neurologists say, play a key role in improving quality of life for patients living with this condition.
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