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A Complete Guide to Trigeminal Neuralgia: What is it and What you Can Do About It

Aug 02, 2022

If you’ve experienced trigeminal neuralgia, then you’ve probably faced what many healthcare professionals say is the most excruciating type of pain a person can experience. Tic douloureux, more commonly known as trigeminal neuralgia, is a medical condition involving intense and unbearable pain in the face or jaws. For individuals with trigeminal neuralgia, managing the chronic orofacial pain stemming from the condition is essential for quality of life. 


What is Trigeminal Neuralgia?


To understand trigeminal neuralgia, it helps to become familiar with the body’s cranial nerves. The trigeminal nerve is one of 12 pairs of cranial nerves that send sensory signals from the brain to the head and torso. Each pair of the cranial nerves have specific tasks, enabling such functions as smell, touch, swallowing, and eye movements. These nerves assist with delivering sensory information and motor information to direct movement. 


Trigeminal Nerves


Specifically, the trigeminal nerves allow the face to feel pain, temperatures, and sensations. They also assist with the movement of various muscles in the face, jaw, and ears. A significant portion of the trigeminal nerves function is to deliver sensory information to the following parts of face:


  • Forehead
  • Scalp
  • Upper sinuses
  • Sinuses
  • Mucous membranes in the eyes 
  • Nose, bridge of the nose 
  • Nasal cavity
  • Front and middle of the tongue
  • Cheeks
  • Lips
  • Chin
  • Mouth
  • Outer ear
  • Teeth and jaws


As you can see, the trigeminal nerves affect many parts of the head and face. When the trigeminal nerves become compromised, significant functional impairments and pain may occur. 


Trigeminal Neuralgia Symptoms 


Because the pain is so severe, the
symptoms of trigeminal neuralgia are noticeable and unmistakable. 

The symptoms of trigeminal neuralgia may include:


  • Painful episodes lasting from a couple of seconds to several minutes.
  • Facial spasms may occur, accompanied by pain.
  • Painful episodes involving the head or face lasting days, weeks, or months. Individuals may go through times of intermittent pain-free episodes. 
  • Spontaneous orofacial pain, especially in the jaw and mouth area.
  • Pain triggered by chewing, brushing teeth, speaking, or touching the face. 
  • Intensifying pain level and frequency over time


The orofacial pain that accompanies trigeminal neuralgia is described as an intense electrical shock-like pain, which often manifests itself during waking hours — and not while the individual sleeps. These painful episodes begin as a short and mild attack and slowly progress to intense pain. 


What causes Trigeminal Neuralgia?


Although various conditions may cause trigeminal neuralgia, the most common cause is a blood vessel pressing directly on the nerve itself. A protective coating called a myelin sheath protects nerves, and compression eventually deteriorates the myelin sheath and impacts the nerve. Injury to the trigeminal nerve, like in a stroke or during a surgical procedure, may also result in trigeminal neuralgia. In rare circumstances, trigeminal neuralgia develops because of nerve compression from a tumor. 


How is Trigeminal Neuralgia Diagnosed?


Diagnosing trigeminal neuralgia involves a thorough assessment to look for the presence of three factors:


  • Sudden, piercing, shock-like pain.
  • Distinct parts of the face that are affected, which align with areas controlled by the trigeminal nerves. 
  • Pain that’s triggered by movement such as talking or eating, as well as external triggers like touch and temperature.


Further examinations may include a neurological exam along with a reflex test. The reflex tests offer clues as to whether the trigeminal nerve is compromised. A healthcare provider may also choose to obtain a Magnetic resonance imaging (MRI) to determine the presence of a tumor or muscle injury.


Treatments for Trigeminal Neuralgia


There’s no cure for trigeminal neuralgia, but treatments exist that can manage or alleviate the pain. The severe orofacial pain that occurs with trigeminal neuralgia is often debilitating, so finding a treatment intervention that works is essential for a person’s quality of life. These are the most common treatments used for trigeminal neuralgia:


  • Anticonvulsant medications to block nerve firing. Some examples of medications prescribed are phenytoin, gabapentin, pregabalin, lamotrigine, and valproic acid.
  • Tricyclic antidepressants alleviate pain and address mood disorders resulting from chronic pain.
  • A surgical procedure called a rhizotomy (rhizolysis) purposefully and strategically injures nerve fibers to block pain signals.
  • A balloon compression surgery in which a tube is inflated against a nerve to curb chronic facial pain.
  • Radiofrequency thermal lesioning, more commonly known as RF Ablation, inserts a hollow needle that passes light electrical currents to damage nerve fibers purposely. In turn, pain sensations become blunted. 


Other Treatments for Trigeminal Neuralgia


Although medication and surgery are the most well-known treatments for trigeminal neuralgia, they work best when combined with other interventions. Lifestyle changes, stress management, and sleep therapy are ways to help manage the pain and anxiety brought about by trigeminal neuralgia. Individuals should consult with their healthcare provider before incorporating any treatments not approved by their treatment teams. 


Trigeminal Neuralgia and Sleep


It’s no surprise that orofacial and neuropathic pain are
impacted by sleep. The relationship between the two is bidirectional — pain affects sleep quality, and sleep quality affects pain. Poor sleep quality leads to increased pain sensitivity, highlighting the need to incorporate sleep therapy into treatment plans for conditions like trigeminal neuralgia. 


In addition, the medications typically chosen for the treatment of trigeminal neuralgia — like anticonvulsants and antidepressants — can adversely impact good quality sleep. About 68% of people with neuropathic pain similar to trigeminal neuralgia experienced disturbed sleep. 


People with trigeminal neuralgia:


  • Are four times more likely to wake up sometime during their sleep.
  • Are more likely to have nightly awakenings due to innocuous stimuli ( like light touch or a breeze).
  • Have higher rates of pain-related sleep disturbances.


Incorporating sleep treatments in combination with trigeminal neuralgia therapies offer the best chances to control and alleviate pain. 


Finding Help for Trigeminal Neuralgia 


If you have symptoms of trigeminal neuralgia, seeing an orofacial pain specialist can help manage your pain.
Dr. Katherine Phillips is board-certified by the American Board of Orofacial Pain and has the background and experience to treat your condition. 


Contact us to learn more about treatment options and let us help manage your trigeminal nerve pain. 

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Dr. Kathrine Phillips
About The Author
Dr. Katherine Phillips, DDS, MS received her undergraduate degree from the University of Michigan and her dental degree from the University of Detroit Mercy School of Dentistry. She currently serves as the Secretary/Treasurer on the American Board of Dental Sleep Medicine (ABDSM) Board of Directors and treats TMD and sleep disordered breathing at Restore TMJ & Sleep Therapy in the Houston, TX area. 
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Teeth grinding is the most common cause of jaw pain. Grinding your teeth also results in fractured teeth and the destruction of dental work, which can even change how you look. People who grind their teeth during the day can make conscious changes to reduce their teeth grinding for those who grind their teeth at night . Fortunately, with a visit to Dr. Phillips, you can discover how to stop grinding your teeth. What is Teeth Grinding, and What Causes it? Grinding or clenching your teeth, or bruxism , is a common condition affecting millions of people and, if left untreated, can lead to broader health issues. According to the American Dental Association (ADA), a 2020 ADA Health Policy Institute report stated that half of the dentists saw a rise in clients with stress-related dental problems, primarily due to teeth grinding and jaw clenching. It can happen during the day or night and often goes unnoticed until the person is alerted by a partner or family member. Treating bruxism can prevent further damage to the teeth and relieve any symptoms associated with the condition, and there are several steps you can take to stop grinding your teeth and protect your oral health. People grind and clench their teeth for various reasons, including stress and anxiety, misalignment of the teeth and jaw, or an abnormal bite. In adults, teeth grinding is often caused by emotional tension and stress and can become a subconscious habit. In children, teeth grinding is usually due to an immature bite and can be triggered by new teeth erupting or the recent placement of braces. How Do You Know if You're Grinding or Clenching Your Teeth? Grinding or clenching your teeth can be challenging to identify since it usually happens when you are unconscious or sleeping. However, several signs could indicate you are grinding your teeth. Common symptoms of teeth grinding include: Waking up with a sore jaw Frequent headaches Increased sensitivity or pain in your teeth Tired or tight jaw muscles Pain that feels like an earache, but there is nothing wrong with your ear A locked jaw that is difficult to open or close completely Neck or face pain Noticing that your teeth feel different or worn down You or your sleep partner may also notice that you make clenching or grinding sounds during the night. At a dental appointment, your dentist may suspect teeth grinding if you have the following: Teeth that are chipped, loose, flattened, or fractured Worn enamel on your teeth Gum recession Possible Causes of Teeth Grinding Many people grind their teeth and tighten their jaws without realizing it, especially at night. Although stress and anxiety can lead to teeth grinding, other common causes are: Posture. Poor posture is not only horrible for your back; it's also bad for your teeth. When the body's joints aren't in proper alignment, it can result in jaw clenching and grinding. Misaligned teeth. If the upper and lower teeth don't fit together correctly, the misalignment may result in the tendency to grind teeth or clench jaw muscles. Sleep disorders. Sleep habits and sleep disorders can lead to teeth grinding at night. Chronic obstructive sleep disorder , also known as sleep apnea , is a known cause of sleep bruxism. Resolving sleep apnea can help stop teeth grinding. Sleep terrors and insomnia may also result in grinding teeth at night. Joint disorders. The temporomandibular region is around the jaw, mouth, and ears. This area contains the temporomandibular joints and jaw muscles, which allow the jaw to open and close. Disorders in this area can affect teeth grinding and a sore jaw. Stimulants. Stimulants like caffeine, nicotine, and alcohol can trigger teeth grinding. Avoiding these can help prevent teeth grinding. Stress. Stress is a common cause of teeth grinding and clenching. Finding ways to manage and reduce stress can help decrease teeth grinding. These can include relaxation techniques such as progressive muscle relaxation, yoga, deep breathing, meditation, and guided imagery can help relax the jaw muscles and stop teeth grinding. Chewing on Objects. Chewing on objects such as pencils or fingernails can trigger teeth grinding. You may also need to avoid chewing gum, which can exacerbate teeth grinding. Finding out how to stop grinding teeth at night takes getting to the root cause of grinding. Discovering the cause provides clues, pointing to the appropriate solutions. Prevent teeth grinding during the day. It is crucial to identify triggers that cause teeth grinding if you intend to stop grinding them during the day. Pay attention to your habits during the day and see if you notice when and if your grinding or clenching is worse. 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Although some treatments aren't quite possible when you're asleep, their benefits can last even after you've gone to bed. Reductive coronoplasty. Reductive coronoplasty directly involves changing or leveling the biting surface of teeth. This procedure reshapes crowded or crooked teeth, improving teeth alignment. Conversely, additive coronoplasty can add to the surface of teeth to help treat bruxism. Dental Appliances: Mouthguards, night guards, and splints. A mouthguard does just that — it guards teeth. Typically used for sports, a mouth guard keeps teeth from injuries sustained during activity. A night guard protects teeth from grinding at night. Lastly, a bit splint guides jaw movement, enabling the jaw to land in the appropriate position. These appliances protect teeth differently, and finding the right one for your situation is essential. Biofeedback. Biofeedback allows a person to train themselves by monitoring auditory and visual stimuli from the body. 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This is because TMJ specialists use a holistic approach to treatment, focusing on the underlying causes of the teeth grinding, such as stress, anxiety, or misaligned teeth, rather than just treating the symptoms. They often work with other medical experts like dentists or sleep physicians for more comprehensive care and treatment. Protecting Your Oral Health Protecting your teeth is critical to taking care of your overall health. Chronic teeth grinding can result in costly dental work, poor oral health, and chronic pain. If you're experiencing a sore jaw, headaches, or cracked teeth, seeking an expert diagnosis to find the cause is the first step to finding a solution. Get the answers you need on how to stop grinding your teeth at night or keep from grinding in the daytime to protect your oral health. As a TMJ and sleep apnea dentist, Dr. Katherine Phillips specializes in diagnosing and treating bruxism. 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