There are two nerves-one on each side of the face- which carry the sensation of face and gums to the brain, where we can appreciate them. They are the Trigeminal nerves. For example, sensations from the right side of the face are carried by the right trigeminal nerve.

‘Neuralgia’ means nerve pain.’

Combining the two words gives the term Trigeminal Neuralgia, meaning pain in the region of the Trigeminal nerve; in short, pain on one side of face and gums. (usually this disease is unilateral).

Trigeminal neuralgia is also called TN, Tic douloureux, facial pain, Fothergill’s disease, Prosopalgia (prosopos=face, algos=pain), prosopodynia (dynos=pain), prosoponeuralgia, trifacial neuralgia etc.

TN is basically a clinical diagnosis. What it means is that we make the diagnosis by carefully listening to the patient’s history and the description of the pain. The typical TN pain has following characteristics:

-It comes suddenly and lasts from a second to many minutes.

-It is in the distribution of the Trigeminal nerve, on one side of the face.

-It can start from upper or lower gum, teeth, nose, chin, cheek, just in front of the ear, forehead, eye, temple and spread to other parts of the face.

-Sudden electric current

-Sudden, piercing, sharp knife in the face

-Electric shock like

-Pricking of multiple sharp needles

-Sudden blast of hot bomb in the face

-Like somebody putting red chilli powder on the face.

-Like a lightning striking the face

The attack terminates in a few seconds or a few minutes and then the person is usually pain-free till the next attack.

In advanced stages, the pain remains for a longer duration of time. Also, there could be continuous low intensity pain between the Trigeminal Neuralgia attacks.

The V2-V3 division is most commonly affected in about 40% patients( jaw and cheek pain). All three branches are affected in only about 10 % of patients.

There are a few commonly seen trigger points, which when stimulated start the attack. These trigger points could be:

• Upper lip, Ala of the nose
• Forehead just above the eye, just below the lower eyelid.
• Just in front of the ear, Upper or lower gum

Touching one or more of these points, blast of cold, even a gentle breeze against the face, brushing teeth (the toothbrush touching the gums), washing face, shaving, jaw movements while talking or chewing etc bring on the attack

This pain surpasses any other pain experienced by humans in severity. Various patients have described this pain as:

• “The worst pain experienced by mankind”
• “The pain you should not wish even your enemies to have”
• “Death be better than this suffering”
• “Deadly curse”
• “Pain of thousand knives piercing the face”
• “A hot chilli bomb exploding on one side of the face”