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Facial neuralgia is an uncommon condition that causes occasional sharp, shooting pains in one side of the face. Almost all cases involve a problem with the trigeminal nerve, the main sensory nerve of the face. A twinge may feel like an electric shock or a burn that lasts for a fraction of a second and causes residual pain for a few minutes. The condition can usually be managed with medications, though surgery may be needed when painful twinges are frequent and debilitating.
The trigeminal nerve splits into three main branches from the base of the brain, feeding the forehead, jaw, and cheek regions. Most cases of facial neuralgia arise when pressure is put on a section of the nerve. Blood vessels in the face can migrate to lie on top of the nerve, a common occurrence in people over the age of 60. Less commonly, a tumor or another abnormal growth can compress the trigeminal nerve. Some cases are idiopathic, meaning that an underlying cause cannot be determined.
Most people who have facial neuralgia have certain triggers that bring about painful twinges. Specific triggers vary, but touching the face, smiling widely, chewing food, or sneezing can all cause episodes. Painful sensations typically last for less than a second, though they can leave the face feeling sore for several minutes. Twinges can be centralized in the cheek, behind the jaw, near the mouth, or close to the eye. Episodes generally become more frequent and painful with time.
A primary care physician can identify facial neuralgia by carefully examining the face and asking about symptoms. After making a basic diagnosis, he or she will typically refer the patient to a neurologist for further examination. The specialist takes magnetic resonance imaging scans to check for abnormalities, such as tumors and displaced arteries, that might be putting pressure on the trigeminal nerve.
Treatment decisions are made with the underlying cause in mind. In the case of idiopathic facial neuralgia, a patient is usually given anticonvulsant medications to lessen activity in the nerve. Muscle relaxants may provide additional relief from symptoms and lessen the likelihood of recurring episodes. When daily medications are taken as instructed, they are sufficient in preventing recurring episodes in most patients. Surgery is considered when symptoms persist or if it is obvious that a blood vessel, tumor, or cyst is causing problems.
A neurosurgeon can treat facial neuralgia in a number of different ways, and most procedures can be performed on an outpatient basis. A surgeon may need to realign blood vessels, cut away inflamed or damaged tissue, or inject a numbing solution directly into the base of the nerve. If other options fail to relieve neuralgia, the nerve can be severed. Shooting pains are guaranteed to stop after cutting the nerve, though the affected side of the face becomes permanently numb.
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