Burning, stabbing, lightening-like pain in your face?  Maybe constant facial aching?  A few seconds to a few minutes of exquisitely agonizing pain beyond imagining?  It could be what’s commonly called tic douloureux or more technically, trigeminal neuralgia, TN.  

At best, TN can be annoying, and at worst it can be completely debilitating.  TN pain can be so bad that you consider ending it all, the reason it’s called the Suicide Disease.

Fortunately, the same treatment I have used effectively for migraine headaches can help to modulate the pain of trigeminal neuralgia.   Depending on the cause, and like migraine remission, these treatments may correct the problem at its base.

A variety of things can bring on a TN episode.  It could be as simple as touching some place on your face, shaving, brushing your teeth, applying cosmetics, and many other apparently innocuous activities.

What’s Happening in Your Body.

The Trigeminal nerve is the fifth major nerve that starts in your brainstem, cranial nerve V, and the most widely distributed nerve in your head.   While it’s treated as a single nerve, it is actually three (tri-) pairs (-geminal) of nerves.  Those three branches innervate the upper, middle, and lower parts of your face as well as your oral cavity.  Along with the vagus nerve, the trigeminal nerve also innervates your meninges, the three layers of tissue that cover your brain, and are the only parts of your brain that can experience pain.

What’s happening with TN is that the trigeminal nerve is being inflamed, being compromised in some way.  It could be a blood vessel pressing on it as it emerges from your brainstem.   Over time this results in the nerve’s protective coating, myelin sheath, being eroded.  Not surprisingly, people with multiple sclerosis, MS, frequently experience TN because the action of MS is progressively to destroy the myelin sheath from many nerves.

There may be injury to the trigeminal nerve resulting from sinus or oral surgery, a stroke, or perhaps some trauma to your face.  A tumor, burns, and allergic reactions are implicated as well.

Is It Really TN?

There are many conditions that can cause facial pain, and it’s important to have a clear medical diagnosis.  Typically, this will include an MRI, and possibly a short course of an antiseizure medication.  Possibilities other than TN include things like TMJ, cluster headaches, and neuralgia (nerve pain) following an episode of shingles.

Treating TN.

The good news is that remission of TN frequently happens spontaneously.  The bad news is that medical treatments for TN, while often effective, have some pretty undesirable downsides. 

The most common first treatment includes anticonvulsive and antidepressant drugs.  These drugs may be effective early on, but they tend to lose their effectiveness, and leave you with TN pain as well as the often serious side effects of the drugs. 

NSAIDS and opioids seem not to be particularly effective against TN.

Surgery.

There is an amazing assortment of surgical procedures that can be performed.    With many of these, it’s likely you will have some degree of numbness in your face, and even if successful, the TN may return.  Other risks of surgery include problems with your balance, loss of hearing, spinal fluid leakage, infection, and a combination of a deep burning pain along with facial numbness.  I think surgery really should be the last thing you try.

Do It Yourself Remedies.

TN sufferers have tried a variety of self-help techniques.   Different ones seem to help in different cases.  

One of the few proven treatments is the CBD oil I make available to my patients.  It is well known now to be effective against a variety of inflammatory conditions.   1 ml of CBD oil a day can be preventive of future attacks as well.

Other examples are applying gentle heat or cold to your face, or applying pressure to the painful area.  While light touch may set off an episode, heavier pressure sometimes decreases the pain.  

As well, you might try a cream made by mixing some cayenne pepper into a bit of olive oil.  Be careful with this as the capsaicin in cayenne can be irritating to sensitive skin.   You can try the same with an assortment of Chinese herbs.  Homeopathic Spegelia has been used as well.

Good Treatments?

The good news is that many are finding help from complementary treatments.  My preferred approach is, of course, my own MKY treatments.  That said, yoga, aroma therapy, and meditation have helped some.   Others include acupuncture, chiropractic, and nutritional therapies.  And some have found Botox injections to be helpful.  Unfortunately, there is no credible research on the effect of these approaches, but they may be worth trying before drugs or surgery.