Trigeminal Neuralgia: Symptoms, Causes, and Stress Connection

Trigeminal nerve

I have been experiencing a dull pain in my upper left molar for about two months.
The sensation is intermittent and varies in duration.
It feels like it's coming from the gum area, and when it hurts, brushing my teeth makes it worse.
I have already had my adjacent wisdom tooth extracted.
A few weeks ago, I visited the dentist, and an X-ray did not reveal any cavities or other issues.
I was wondering if it could be related to the trigeminal nerve, but after looking up information online, my pain is not unbearable, and I am only 22, which is not the typical age for this condition.
I have seen some information linking stress to trigeminal nerve issues, but it has not been confirmed yet.
I tend to feel stressed easily, and I have a history of irritable bowel syndrome, gastroesophageal reflux disease, and irregular menstruation.
I would like to ask the doctor if my current situation resembles trigeminal neuralgia.
Is trigeminal neuralgia related to stress?

L, 20~29 year old female. Ask Date: 2016/02/11

Dr. Jiang Junyi reply Neurology

Hello, according to your description, the trigeminal nerve has three branches that are responsible for sensation in the facial areas of the eyes, upper jaw, and lower jaw.
Trigeminal neuralgia is characterized by severe, electric shock-like, sharp pain localized to the areas innervated by the trigeminal nerve branches.
It typically occurs unilaterally and can start and stop suddenly, with durations that can vary from a few seconds to several tens of seconds.
It may be triggered by certain activities, such as touching the skin on the face, eating, yawning, washing the face, brushing teeth, speaking, or exposure to cold air.
Pain episodes can last from a few weeks to one or two months, followed by a period of remission before another episode occurs.
Trigeminal neuralgia frequently occurs in the areas supplied by the lower two branches, while its occurrence in the first branch area is relatively rare.
Aside from the presence of trigger points, general neurological examinations are usually normal.
Diagnosis primarily relies on the patient's medical history and symptoms, and it is essential to rule out other causes of trigeminal neuralgia, such as tumors, vascular malformations, or multiple sclerosis.
Since the trigeminal nerve innervates the upper and lower jaws, the presentation of the pain can sometimes closely resemble dental pain, leading patients to mistakenly believe they have a dental issue, which can result in dentists misdiagnosing and extracting teeth.
If your pain does not align with the distribution of the trigeminal nerve, other conditions should be considered.
It is advisable to consult a neurologist for further evaluation and treatment.
Wishing you good health and peace.

Reply Date: 2016/02/11

More Info

Trigeminal neuralgia (TN) is a chronic pain condition that affects the trigeminal nerve, which is responsible for sensation in the face and motor functions such as biting and chewing. 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, including light touch, chewing, or even a breeze.

In your case, the symptoms you describe—occasional dull pain in the upper molar area, particularly when brushing your teeth—could potentially be related to trigeminal neuralgia, although the pain you experience does not seem to be as severe as typically associated with this condition. The fact that you have already undergone dental examinations, including X-rays, which did not reveal any dental issues, is a positive step in ruling out other causes of your discomfort.

The connection between stress and trigeminal neuralgia is an area of interest in medical research. Stress can exacerbate many chronic pain conditions, including TN. When a person is under stress, the body releases certain hormones that can heighten pain sensitivity and lead to muscle tension, which may contribute to the perception of pain. Additionally, stress can lead to behaviors such as teeth grinding (bruxism), which can further irritate the trigeminal nerve and potentially trigger pain episodes.

Given your history of anxiety and stress-related conditions, such as irritable bowel syndrome (IBS) and gastroesophageal reflux disease (GERD), it is plausible that stress could be a contributing factor to your current symptoms. Chronic stress can lead to a cycle of pain and anxiety, where the pain causes more stress, which in turn exacerbates the pain.

It is also worth noting that while trigeminal neuralgia is more common in individuals over the age of 50, it can occur in younger individuals as well. The condition can be idiopathic (without a known cause) or secondary to other conditions, such as multiple sclerosis or structural abnormalities that compress the trigeminal nerve.

To address your concerns, it would be advisable to consult with a neurologist or a pain specialist who can conduct a thorough evaluation of your symptoms. They may recommend imaging studies, such as an MRI, to rule out any structural causes of your pain. Additionally, they can discuss treatment options, which may include medications such as anticonvulsants or muscle relaxants, and lifestyle modifications to manage stress.

In summary, while your symptoms may not fully align with classic trigeminal neuralgia, they warrant further investigation, especially considering your stress levels and their potential impact on your pain perception. Managing stress through techniques such as mindfulness, cognitive behavioral therapy, or relaxation exercises may also provide some relief. It is essential to work closely with healthcare professionals to develop a comprehensive treatment plan tailored to your specific needs.

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