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Facial neuralgia causes sharp, shooting pains in one side of the face and is often caused by pressure on the trigeminal nerve. It can be managed with medication, but surgery may be needed for severe cases. Triggers include touching the face, chewing, and sneezing. Treatment decisions depend on the underlying cause, and surgery can be done on an outpatient basis.
Facial neuralgia is a rare condition that causes occasional sharp, shooting pains in one side of the face. Almost all cases involve a problem with the trigeminal nerve, the main sensory nerve in the face. A twinge can feel like an electric shock or a burn that lasts a fraction of a second and causes residual pain for a few minutes. The condition can usually be managed with medication, although surgery may be needed when the pangs of pain are frequent and debilitating.
The trigeminal nerve divides into three main branches from the base of the brain, feeding the forehead, jaw, and cheek regions. Most cases of facial neuralgia occur when pressure is placed on a section of the nerve. Blood vessels in the face can migrate until they are over the nerve, a common occurrence in people over the age of 60. Less commonly, a tumor or other abnormal growth can compress the trigeminal nerve. Some cases are idiopathic, meaning that an underlying cause cannot be determined.
Most people who have facial neuralgia have certain triggers that bring on painful twinges. Specific triggers vary, but touching the face, smiling broadly, chewing food, or sneezing can cause episodes. The painful sensations typically last less than a second, although they can leave your face in pain for several minutes. The stitches can be centralized in the cheek, behind the jaw, near the mouth, or near the eye. The episodes generally become more frequent and painful over time.
A primary care physician can identify facial neuralgia by carefully examining the face and asking about symptoms. After making a basic diagnosis, it typically refers the patient to a neurologist for further testing. The specialist does MRI scans to check for abnormalities, such as tumors and displaced arteries, that could be putting pressure on the trigeminal nerve.
Treatment decisions are made with the underlying cause in mind. In the case of idiopathic facial neuralgia, a patient is usually given anticonvulsant medications to reduce the nerve’s activity. Muscle relaxants can provide additional symptom relief and reduce the likelihood of recurring episodes. When daily medications are taken as directed, they are sufficient to prevent recurrent episodes in most patients. Surgery is considered when symptoms persist or if it is evident that a blood vessel, tumor or cyst is causing problems.
A neurosurgeon can treat facial neuralgia in a number of ways, and most procedures can be done on an outpatient basis. A surgeon may need to realign blood vessels, cut away inflamed or damaged tissue, or inject a numbing solution directly into the base of the nerve. If other options fail to relieve the neuralgia, the nerve may be severed. The excruciating pains are guaranteed to stop after cutting the nerve, although the affected side of the face goes permanently numb.
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