Trigeminal Neuralgia: Insights from TMJ Disorders

Temporomandibular joint disorder causing trigeminal neuralgia?

Hello, my symptoms began four years ago when I bit down on a hard object, resulting in a sudden electric shock-like pain in the left side of my face.
Over the past few years, I have consulted with neurosurgeons, dentists, traditional Chinese medicine practitioners, and physical therapists.
After multiple evaluations from different dental clinics, my teeth appear to be normal.
A year ago, a neurosurgeon performed an MRI and confirmed that there were no tumors, so I was prescribed Trileptal.
I also consulted a dentist specializing in temporomandibular joint (TMJ) disorders, who diagnosed me with dislocated cartilage in both TMJ joints, with the right side being significantly worse than the left.
There is bone thickening (right side degenerative stage II / left side stage I), and both sides show poor muscle quality, indicating that the muscles are not being used normally.
The doctor believes that my trigeminal neuralgia is not caused by the TMJ cartilage issues.

In November of last year, I thought my symptoms were improving; I had no nerve pain, only muscle pain in the left TMJ.
However, starting in February of this year, the symptoms recurred, and the nerve pain became more frequent.
Sometimes, walking, drinking water, pursing my lips, or sitting can unintentionally trigger the pain, which can reach a pain level of 9.5.
During this time, I self-medicated with Trileptal purchased from a pharmacy and also visited a traditional Chinese medicine practitioner.
The TCM diagnosis indicated that several meridians were very tight.
After a month of acupuncture, my pain level decreased to 6.5, but I still occasionally experience nerve entanglement on the left side of my face, which easily triggers trigeminal neuralgia.
I would appreciate any suggestions you may have.
Thank you, doctor.

Kenny, 30~39 year old female. Ask Date: 2024/03/18

Dr. Jiang Junyi reply Neurology

Dear Mr.
Kenny,
You mentioned "trigeminal neuralgia." The cause of trigeminal neuralgia is primarily due to abnormal transmission of sensory signals by the trigeminal nerve.
Approximately 80% of cases are caused by vascular compression of the trigeminal nerve at its entry point from the brainstem.
Other causes, such as vestibular schwannoma, meningioma, multiple sclerosis, and herpes zoster, can amplify normal sensory signals like touch and temperature into pain signals, leading to the symptoms of trigeminal neuralgia.
You have already ruled out brain tumors.
The treatment for trigeminal neuralgia mainly involves anticonvulsant medications, with the most commonly used being carbamazepine (Tegretol), oxcarbazepine (Trileptal), and lamotrigine.
Additionally, injection therapies can be considered, where medications are injected into the trigeminal ganglion to achieve pain relief.
Commonly used agents include botulinum toxin and local anesthetics, which are often utilized for refractory trigeminal neuralgia, although they may not provide long-term relief.
For refractory trigeminal neuralgia that does not respond well to medications, options include microvascular decompression of the trigeminal nerve root, nerve block techniques, and gamma knife radiosurgery.
Recent studies have also suggested that transcranial magnetic stimulation may help modulate the overactivation of pain pathways in the brain.
Thank you for your inquiry! I welcome further discussion.
Wishing you good health and peace.
Sincerely,
Dr.
Jiang Junyi

Reply Date: 2024/03/18

More Info

Trigeminal neuralgia (TN) is a chronic pain condition that affects the trigeminal nerve, which is responsible for sensation in the face. It is characterized by sudden, severe, and recurrent episodes of facial pain, often described as sharp, stabbing, or electric shock-like sensations. The pain can be triggered by various stimuli, such as touching the face, chewing, speaking, or even exposure to wind. Your symptoms, particularly the electric shock-like pain on the left side of your face, align with the typical presentation of trigeminal neuralgia.

In your case, the onset of symptoms following an incident where you bit into a hard object raises the possibility of nerve irritation or injury. While your MRI results ruled out tumors, it is essential to consider other factors that may contribute to your condition. The involvement of the temporomandibular joint (TMJ) and the diagnosis of dislocated cartilage in both joints could be significant. TMJ disorders can lead to muscle tension and altered facial mechanics, potentially exacerbating or mimicking trigeminal neuralgia symptoms.

The treatment for trigeminal neuralgia often begins with medications. Carbamazepine (Trileptal) is a common first-line treatment, as it can help stabilize nerve activity and reduce pain. However, it seems that your pain has persisted despite medication, which is not uncommon in chronic pain conditions. The fact that you have sought various treatments, including physical therapy, acupuncture, and consultations with specialists, indicates a proactive approach to managing your symptoms.

Given that your pain has become more frequent and intense, it may be beneficial to revisit your treatment plan. Here are some suggestions:
1. Neurologist Consultation: Since trigeminal neuralgia can be complex, consider consulting a neurologist who specializes in pain management. They may suggest alternative medications or treatments, such as gabapentin or baclofen, which can also be effective for nerve pain.

2. Pain Management Specialist: A pain management specialist can offer additional options, such as nerve blocks or other interventional procedures that may provide relief.

3. Physical Therapy: Continuing physical therapy focused on the jaw and neck may help alleviate muscle tension and improve function. A therapist experienced in TMJ disorders can provide targeted exercises and techniques.

4. TMJ Treatment: Since your TMJ condition is contributing to your symptoms, addressing it directly may help. This could involve the use of a night guard, physical therapy, or other dental interventions to improve joint function and reduce pain.

5. Alternative Therapies: While acupuncture has provided some relief, consider exploring other complementary therapies, such as biofeedback, mindfulness meditation, or cognitive-behavioral therapy, which can help manage chronic pain.

6. Lifestyle Modifications: Stress management techniques, regular exercise, and a balanced diet can also play a role in managing chronic pain. Avoiding known triggers, such as certain foods or activities that exacerbate your symptoms, is crucial.

7. Follow-Up: Regular follow-up with your healthcare providers is essential to monitor your condition and adjust your treatment plan as needed.

In summary, trigeminal neuralgia can be a challenging condition to manage, especially when compounded by TMJ disorders. A multidisciplinary approach involving neurologists, pain specialists, and dental professionals may provide the best outcomes. It’s important to remain persistent in seeking relief and to communicate openly with your healthcare providers about your symptoms and treatment responses.

Similar Q&A

Understanding Jaw Pain: Is It TMJ Disorder or Trigeminal Neuralgia?

Hello Doctor, recently I have been experiencing pain when biting down on the right side of my teeth, with a sensation of soreness and weakness. When the pain and tingling become severe, it radiates to the area in front of my ear, causing intermittent itching and a slight feeling ...

Dr. Cai Zongzhang reply Neurology
Hello: Trigeminal neuralgia can vary in severity. The symptoms mentioned may still indicate trigeminal neuralgia. It is recommended to visit a neurology clinic for examination and treatment.

Trigeminal Neuralgia or Migraine: Understanding Your Facial Pain

Hello doctor, I started having a cold at the end of June, which developed into sinusitis, but by the end of July, I had mostly recovered. However, I have been experiencing several issues since then. Every morning, I feel a sense of fullness in my right ear, and my hearing doesn&#...

Dr. Jiang Junyi reply Neurology
Hello: The branches of the trigeminal nerve are distributed from top to bottom in the forehead, cheeks, and chin. Trigeminal neuralgia often occurs in the areas innervated by its lower two branches, with a lower incidence in the region of the first branch. Additionally, trigemina...

Understanding Trigeminal Neuralgia: Symptoms, Causes, and Treatments

Trigeminal neuralgia, often referred to as tic douloureux, is characterized by sudden, severe, and recurrent episodes of facial pain. The pain typically occurs in the distribution of the trigeminal nerve, which can affect areas such as the cheeks, jaw, teeth, gums, and sometimes ...

Dr. Cai Mengru reply Family Medicine
Dear Mr. Abo, Regarding your question, trigeminal neuralgia is characterized by paroxysmal facial pain, presenting as episodes of sharp or stabbing sensations. The trigeminal nerve is the fifth pair of cranial nerves, and it is named for its three branches: the ophthalmic branch...

Unexplained Tooth Pain: Could It Be Trigeminal Neuralgia?

Hello Doctor: About one or two months ago, I started experiencing unexplained sharp pain in my teeth (specifically in the lower right back teeth), and sometimes I even wake up in the middle of the night due to the pain. I went to see a dentist who took X-rays but found no issues,...

Dr. Lin Zijing reply Neurology
The pain sensation in the teeth is a branch of the trigeminal nerve. Typical trigeminal neuralgia is characterized by sudden, severe unilateral facial pain that feels like a knife or electric shock, which then abruptly disappears, only to recur shortly thereafter. Most individual...