I have had terrible pain and aching in the side of face for about four years. Thinking it was my teeth, I spent a fortune at the dentist, but it made no difference. The doctor says that it’s ‘trigeminal neuralgia’. I’m on a drug called carbemazepine but I still have days when it hurts just to talk or wash. It can also hurt round my eyes, which become red and puffy underneath. Have you any suggestions, please?
I get many letters about this debilitating problem, which I am sure your doctor has diagnosed correctly, Neuralgia refers to nerves. Cords of nerves, bundled, up in fibres surrounded by a protective sheath, run with messages from the central nervous system (the brain and spinal cord) to the muscles, skin and other body organs. Twelve pairs of cranial nerves come from the brain. Sensory nerves pick up touch, pressure, vibration, heat, cold and pain, as well as vision, taste, smell and hearing. Motor cranial nerves carry out the movements of the facial, eye, tongue, swallowing and speech muscles, and of the diaphragm.
The fifth and largest cranial nerve is a mixed nerve, called trigeminal because it has three branches. The top one supplies the upper part of the face, the middle one goes to the cheeks, nose and upper lip, and the lower one to the mouth, teeth, tongue and lower jaw. If the trigeminal nerve malfunctions, it can cause sensory problems including pain or motor complications such as difficulty chewing. Tic douloureux is a painful facial spasm that may occur with trigeminal neuralgia. The nerves are so sensitive that the tic can be triggered by a light touch, strong breeze, even a movement. Each attack can last for several minutes to several hours. The pain is so intense that some people opt to have the nerve surgically destroyed and face the prospect of a numb mouth, rather than more attacks.
Trigeminal neuralgia is hard to treat, its the underlying cause is still not known. Strong painkillers are usually prescribed, and sometimes anti-epileptic drugs, such as carbemazepine, to suppress the spasm or tic. The problem, from what you say, is that yours is not the tic type but comes in waves.
My suggestions for mitigating the painful bouts are as follows
* Eat soft foods, so that you don’t need to chew a lot. Try soup, mushy rice, mashed potatoes, minced meat, turkey and chicken, overcooked or pureed vegetables, porridge soft-boiled eggs, mashed bananas and fresh non-citrus fruit and vegetable juices.
* Avoid cold foods, such as ice cream or ice cold drinks, also citrus fruits, coffee, excess salt, sugar and alcohol, which can all aggravate the pain.
* I have found massage and acupuncture to be the best form of treatment My special neck massage improves the blood flow to the brainstem and midbrain, via the vertebral arteries in the neck. These arteries have tiny blood vessels (called vasa nervorum) sprouting from them, which feed the trigeminal and other cranial nerves. Improving blood flow to nerves can cure inflammation. I have massaged the necks of patients in the middle of an attack and witnessed instant relief. Rub along the sides of the neck and also give the neck traction by putting your hands round the base of the skull and very gently pulling it away from the shoulders.Also massage trigger points behind the ears, down the jaw, under the lower lip and down the lines from nose to mouth. Massage these points with your thumb or index finger for one or two minutes each, twice a day, until the pain vanishes.
* To help you relax, take Biorelax: one twice daily for one month. Also take vitamin B-complex: one daily for two months. Listening to relaxation CD or tape in the evenings before bed should also help.
* As soon as you feel an attack coming on, do the following retention breathing exercise for five minutes. Inhale deeply and hold your breath for 10 to 15 seconds, then – just when you think you are about to burst (don’t panic) – breathe out very gently. Inhale slowly and hold your breathe again for as long as you can. Practise daily, so that it redness and puffiness under your eyes, I suspect that this may be linked to the autonomic nervous system, which controls involuntary functions, including breathing and body temperature control, rather than the effects of the trigeminal neuralgia I think it would be worth asking your doctor to investigate. Perhaps you could be referred to a neurologist for more tests.