It Might Not be TN
IT MIGHT NOT BE TN...
TN is rare, so it is just possible that your GP or dentist might know about it theoretically, but might never have actually had a patient with it. This means that diagnosis is difficult – in other words, it might be incorrect. To make matters even trickier, there are other types of facial pain that can fairly easily be confused with TN.
Check your symptoms against this list, because it might NOT be TN.
The causes of facial pain fall into three basic categories; neurological, vascular and dental.
If you have severe sharp stabbing, ‘electrical’ pains experienced deep inside your ear, this could be your problem. As with TN, it is usually caused by a blood vessel compressing the nerve, and the pain can be triggered by a light touch, yawning, talking or chewing. On the positive side, the pain is usually fleeting, and responds to the same anticonvulsant medications used for TN.
The intense stabbing, shock-like pain is similar to TN, caused by a blood vessel compressing a nerve. Lasting one to two minutes, the pain is primarily in the back of your tongue, throat, and ear and under the angle at the base of the jaw. Swallowing, cold drinks, talking or coughing trigger it off. As with TN, it is treated with anticonvulsant medication, and additionally with anaesthetic throat spray for instant relief during an attack. The good news is that sometimes it goes away entirely.
Experienced as pain on one side of the top of your head, it is a constant aching throb with occasional stabs that are not provoked by facial movements or touch. The cause can be arthritis, a whiplash neck injury, or even a tumour. The condition may respond to anticonvulsants, antidepressants or in some instances a good osteopath. If an MRI scan reveals a tumour, don’t despair, it can be removed.
‘Herpetic’ refers to herpes zoster or shingles. Sometimes after you have had shingles it returns six months later as a constant burning, throbbing pain across the eye and forehead, with ultra-sensitive skin. The symptoms respond to anticonvulsants or antidepressants, and if you are among the fortunate 60 percent, it will eventually cease completely.
This burning pain is the result of physical damage to the trigeminal nerve. Have you hit your head, been involved in a car accident or had dental surgery? If so, this might be the cause of your condition. Although it can be difficult to treat, it is not unknown for the nerve to heal quite satisfactorily. Meanwhile there is a range of options for treatment, anti-inflammatories, anticonvulsants, analgesic ointments, or electrical nerve stimulation (TENS).
SUPERIOR LARYNGEAL NEURALGIA
This condition produces sharp TN type stabbing pains in your lower jaw, the base of the ear, and one side of the throat. The symptoms are triggered by swallowing, straining the voice, yawning or turning your head. Anaesthetic throat sprays bring temporary relief, along with anticonvulsants. But if they don’t help, you have the option of surgery.
If you suffer from a constant dull burning and tingling sensation, with hypersensitivity spreading from your forehead down to the jaw, on one side only, the diagnosis might be trigeminal neuritis. The cause can be injury to the trigeminal nerve, or possibly a viral or bacterial infection, or even a reaction to a toxin or allergen. Your medication would depend upon the suspected cause, either antibiotics or anti-inflammatories.
CLUSTER TIC SYNDROME
Possibly the most confusing to diagnose, this is a rare combination of TN plus cluster headaches. (see below) The jury is out on whether it is two separate conditions suffered simultaneously, or a distinct neurological complaint in itself. This means the syndrome is treated as two conditions, with two types of medication. For the lucky few, the cluster headaches may eventually disappear, although the TN will probably persist.
This condition often runs in families. As with TN, the pain is on one side of the face, although the side can vary. It is episodic rather than continuous. The bouts last anything from a week to a month and painkillers are ineffective. Unlike TN, the pain is searing, burning and radiates from the temple and eye, making it constantly red and watery. Lying down makes matters worse and, as if that’s not enough, it can strike while you sleep. On the brighter side, a wide range of medications can alleviate the situation, and sometimes it goes away and never returns.
This is particularly confusing; the pain feels like a severe toothache. But exactly as with TN, your dentist won’t find anything wrong with the tooth, and painkillers have no effect. But unlike TN, the pain is not paroxysms of short sharp intense episodes several times during the day; this is experienced as a constant burning, aching throb. And although depression is not the cause, anti-depressants can be a successful treatment.
If you have severe throbbing headaches that cause nausea, but they are in the face – below eye-level – seeming to emanate from nostrils, cheeks, gums and teeth, lasting anything from three hours to three days, it is facial migraine. Although it can initially be confused with TN, but facial migraine is triggered by stimuli such as caffeine, alcohol, stress, bright lights, noise or hormonal changes. And unlike TN, the pain responds to analgesics and changes in lifestyle.
CHRONIC PAROXYSMAL HEMICRANIA
Do you have paroxysms of throbbing, pulsating pain on one side of the upper face, several times a day, lasting from 2 to 45 minutes? If so, this could be your problem. In some instances the pain radiates from your eye and temple, cheek or forehead, down to the shoulder, and additionally you might have a runny nose. Fortunately this responds to medication normally used for arthritis.
This condition affects people over the age of 50 who have ‘normal’ headaches, which suddenly feel totally different. The pain is constant and intense, it throbs, burns and radiates from one temple that feels tender to the touch, and your vision may be blurred. Eating seems to provoke it. The cause is an inflamed artery. The condition can be diagnosed by a blood test; so if you suspect that might be your problem, insist on having one. The disorder can lead to a loss of sight unless each recurring bout is treated with steroids.
Although this is sometimes confused with TN because it radiates to your teeth, jaws and ears, with sensitive spots that trigger it, the pain is a dull ache, not electrical stabs. This condition makes it painful for you to chew or open your mouth wide, and produces a taut area of hard knotted muscle. There are various causes including grinding teeth, jaw clenching, a blow on the jaw, infections, stress or even vitamin and mineral deficiencies. The treatments and therapies are equally varied.
TEMPOROMANDIBULAR DISORDER (TMD)
Relatively common, the achy pain of TMD located around your ear and the axis joint of your jaws is due either to an injury, grinding and clenching teeth or teeth meeting incorrectly. Treatment varies from painkillers and antidepressants, to relaxation, massage, or a dental splint to readjust the bite.
The throbbing ache of TMD includes both sides of your face – temples, jaw muscles, nerves, tendons and ligaments. Your jaw feels ‘locked’ and cannot be opened without pain, making eating and speaking very difficult. If none of the above treatments are helpful, anaesthetic injections or acupuncture can be tried, although with any luck, the problem might eventually just disappear.
The most prevalent causes of facial pain are due to problems with teeth. These range from a cracked or broken tooth, an exposed nerve or dentine, advanced decay, temperature sensitivity, gum disease, ‘dry socket’ following a tooth extraction, or a damaged jaw bone.
This is an infection of the sinuses that causes pain across cheeks and forehead. Occasionally it is confused with TN although it affects both side of the face. Antibiotics usually clear it within three months, but if it is chronic, surgery will resolve the problem. However, if you have recently had a tooth extracted, get the area X-rayed, just in case a fragment of tooth has been left behind.
It is always a good idea to get regular eye checks as problems might cause head or face pain, as can wearing spectacles that are too tight.
Please also read 'Other Causes of Face Pain' for more in-depth information.
Page last updated on 11 Aug 2015