Trigeminal Neuralgia: An Early Multiple Sclerosis Symptom

A type of nerve pain called trigeminal neuralgia (TN) can be very hard to cope with and has become known as an early symptom of multiple sclerosis.

Trigeminal neuralgia affects the fifth cranial nerve (trigeminal), which is responsible for the sensation in the face involved with biting and chewing. It is the largest of the cranial nerves and gets its name from the fact that each nerve has three major branches.

People with trigeminal nerve pain can have attacks that last for days, weeks or even months at a time. Sadly, in some cases, attacks happen literally hundreds of times a day. It is possible for some sufferers to go into remission for long periods, although doctors have noticed that periods of remission in their patients seem to get shorter as time goes on.

This type of neuropathic pain is described as severe facial pain – like a sharp, shooting or electric shock. The nerve pain can last a few seconds or a few minutes and then just end abruptly. In the vast majority of cases, it impacts part or all of one side of the face. Most people with trigeminal pain complain about discomfort in the lower part of the face.

Some people who have suffered this kind of nerve pain for years go on to develop a continuous aching, throbbing or burning sensation, along with the sharp pain.


Trigeminal neuralgia (TN) and multiple sclerosis (MS)

According to the American Association of Neurological Surgeons (AANS), TN is now known as an early symptom of MS, the autoimmune disease of the central nervous system (CNS). In fact, AANS states that MS is “usually the cause” of trigeminal nerve pain in young adults.

Studies show that an estimated five per cent of patients with TN also have MS, and about two per cent of people who suffer from MS will go on to develop trigeminal nerve pain.

Research also shows that people with MS are about 20 times more likely to develop TN than those who do not have MS. Patients with both nerve pain and MS tend to be younger than those without MS. Whether you have MS or not, TN seems to impact both sides of the face; however, it is more common on both sides in people with MS.

Clearly, TN causes are different depending on whether or not you have MS.


Causes and triggers

The causes of trigeminal nerve pain are still being investigated, but what we do know is that the face has trigeminal nerves that split into three branches that can transmit sensations of pain from the face, mouth and teeth to the brain. This works much like the sense of touch. When someone touches your face, the nerve senses this and transmits the sensation to your brain so that you feel the touch.

Medical science tells us that most cases of TN are caused by blood vessels pressing on the root of the trigeminal nerve. As a result, the nerve transmits pain signals. With MS, it is believed that the myelin sheath – the protective covering surrounding the nerve fibres in the brain and spinal cord – becomes damaged. When this happens, nerve impulses slow or may even stop, causing neurological problems. Some medical experts also suspect that a tumour pressing on the nerve could cause the signs and symptoms of TN. Dental or surgical procedures that damage the nerve or an infection are also possible causes.

The early signs of TN are abrupt. They seem to come out of nowhere, taking people by surprise. Since the pain is unexpected at first and it is intense, sufferers can become distraught.

The signs and symptoms of TN can vary from person to person and they tend to follow patterns.

If someone has nerve pain, they could experience one or more of the following symptoms and pain patterns:

·         Periodic episodes of severe, shooting pain that feels like an electric shock

·         Spontaneous attacks of pain triggered by chewing, speaking, brushing teeth or even touching the face

·         Pain lasting from a few seconds to several minutes

·         Constant aching, burning

·         Pain attacks lasting days, weeks or even months

·         Pain that goes into the gums, lips or possibly the eyes and forehead as well

·         Attacks that become more frequent and more intense over time

·         Pain affecting one side of the face at a time


Home remedies

It is important to discuss all options with your doctors when it comes to pain management, including home remedies. TN can strike at any time day or night, and you will want to be able to administer pain relief at home.

Simple, daily activities such as eating, shaving and brushing teeth can trigger trigeminal nerve pain, so remember to be gentle and take note of what causes flare-ups. You can also make a list of possible home remedies to try. Here are a few suggestions:

·         Include essential fatty acids in your diet to help reduce inflammation. They are found in natural foods like nuts and avocados, grapeseed oil, sesame oil, canola oil, almonds and cashews. Omega-3 fatty acids and vitamin B can strengthen cranial nerves, including the trigeminal nerve.

·         Cayenne pepper and olive oil. Capsaicin from cayenne pepper is said to block pain by decreasing Substance P, a chemical that transmits pain signals between nerves. You simply rub it onto the skin.

·         Kava Kava is an herb that acts as an analgesic in many types of pain, including nerve pain.

·         Liquorice root and peony – together they have been known to be very effective in bringing relief to people with T. It is commonly available in powder form.

·         Vitamins B3, B5, B1, B2, B6, vitamin C and folic acid can be found in carrot/avocado juice and are excellent nutrients for those with nerve pain. These vitamins support the nervous system.


Treatment and prevention

There is no known cure for TN, but there is treatment. Like most nerve pain, trigeminal nerve pain does not respond to common painkillers; however, there are certain medications that are effective in reducing the discomfort that comes with the condition. A lot of the drugs can take several treatments before they begin to work and, as is the case with many medications, there can be side effects. In some cases, doctors will prescribe a medication that will relax muscles. This can ease pain.

The National Institute for Health and Care Excellence issues guidelines for the treatment of nerve pain. They also support a number of surgical procedures to treat TN. The kind of procedure will vary from person to person. Some people may undergo glycerol injections. These injections take place where the three main trigeminal nerve branches join together. Some patients will go through what is called gamma knife or radiofrequency lesioning. This is when a needle is used to apply heat to a certain area of the nerve to relieve the pain. Balloon compression is another procedure where a tiny balloon is passed along a thin tube inserted through the cheek and then inflated around part of the nerve to squeeze it. The balloon is then removed.

Along with medical treatments, there are steps people can take to help manage TN themselves. They can identify and avoid triggers. For example, if hot or cold drinks trigger attacks then avoid really hot or cold beverages. If pain is the result of activities you can’t avoid, such as brushing your teeth, then an occupational therapist may be able to help you adjust your technique.

There is no denying that living with TN can be a challenge; the constant patterns of pain can be draining. The condition can lead to lack of sleep, depression and isolation. If you or someone you care about is suffering from multiple sclerosis and trigeminal nerve pain, support and encouragement are important. In some cases, MS nurses and GP’s can refer those who are suffering to a psychologist, who can help them cope with the chronic pain and stay positive. – Bel Marra Health