Is Your Facial Pain Trigeminal Neuralgia? the Symptoms

It feels like trigeminal neuralgia?

The painful area is located on the left cheek, approximately around the focal point between the eyes and nose, and the region opposite the ear near the zygomatic bone.
The pain feels dull and achy.
I have braces and frequently undergo X-rays, so dental cavities should be ruled out.
This pain has occurred multiple times in the past, specifically in January, August, and today, November 29.
The earliest memory of this pain dates back about seven years, typically occurring two to three times a year.
When the pain is more severe or lasts longer, I start to feel nauseous, and after vomiting completely, the pain subsides.
I visited a clinic in August this year because I felt so unwell that my face and lips turned pale.
During that visit, I mentioned the cheek pain to the doctor, but they suggested it was likely just acute gastroenteritis.
However, I am experiencing mild pain again today, which has led me to question whether it could be something else, as I found online.
I would appreciate your clarification on this matter.
Thank you very much!

Liu, 20~29 year old female. Ask Date: 2023/11/30

Dr. Jiang Junyi reply Neurology

Dear Ms.
Liu,
You mentioned that you feel a dull pain near the focal point between your eyes and nose, as well as in the area of the cheekbone opposite your ears.
This distribution of pain is associated with abnormalities of the second branch of the trigeminal nerve (maxillary branch).
However, typical trigeminal neuralgia usually occurs unilaterally and rarely affects both sides simultaneously.
Pain is more commonly associated with the maxillary and mandibular branches.
The pain is characterized by severe, superficial, sharp, paroxysmal episodes, with intensity ranging from moderate to severe.
There are no warning signs prior to the pain, which can feel like electric shocks, pinpricks, cuts, or burning sensations, and it may recur after subsiding.
Your symptoms may also warrant consideration of migraine symptoms, such as nausea and vomiting.
I recommend that you consult a neurologist for discussion and treatment.
Thank you for your inquiry, and feel free to reach out for further discussion on related issues!
Wishing you good health and peace,
Dr.
Jiang Junyi, Taoyuan Hospital

Reply Date: 2023/11/30

More Info

Based on your description, it seems that you are experiencing facial pain that could potentially be related to trigeminal neuralgia (TN), but there are several factors to consider before reaching a conclusion. Trigeminal neuralgia is characterized by sudden, severe, and recurrent episodes of facial pain, often described as sharp, stabbing, or electric shock-like sensations. This pain typically occurs in the distribution of the trigeminal nerve, which includes areas around the eyes, cheeks, and jaw.

Your symptoms, particularly the location of the pain around the cheekbone, near the eyes and nose, align with the areas innervated by the trigeminal nerve. The fact that you have experienced these episodes multiple times over the years, along with the intensity of the pain leading to nausea and vomiting, raises the possibility of trigeminal neuralgia. However, it is essential to differentiate this condition from other potential causes of facial pain.

Given that you have a history of dental treatments and X-rays due to wearing braces, it is reasonable to consider that dental issues could be ruled out. However, other conditions such as sinusitis, dental abscesses, or even temporomandibular joint (TMJ) disorders can also cause similar facial pain. Additionally, the pain you described occurring in episodes and being severe enough to cause nausea is significant and warrants further investigation.

It is crucial to consult with a neurologist or a healthcare professional specializing in facial pain to obtain a proper diagnosis. They may recommend imaging studies, such as an MRI, to rule out any structural issues or lesions that could be affecting the trigeminal nerve. Furthermore, a thorough clinical evaluation will help determine if your symptoms are indeed consistent with trigeminal neuralgia or if they may be attributed to another condition.

In terms of treatment, trigeminal neuralgia is often managed with medications such as carbamazepine or oxcarbazepine, which are anticonvulsants that can help alleviate the pain. In some cases, if medication is not effective, other treatment options such as nerve blocks or surgical interventions may be considered.

It is also important to address the nausea and vomiting that accompany your pain episodes. This could be a response to the intensity of the pain, and managing the pain effectively may help alleviate these symptoms as well.

In summary, while your symptoms may suggest trigeminal neuralgia, it is essential to undergo a comprehensive evaluation by a healthcare professional to confirm the diagnosis and rule out other potential causes of your facial pain. Early intervention and appropriate management can significantly improve your quality of life and reduce the frequency and severity of pain episodes. Please seek medical attention promptly to discuss your symptoms and explore the best course of action for your situation.

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