DECEMBER 2015/JANUARY 2016 BY NEIL H. RASKIN, MD, FAAN Does Trigeminal Neuralgia Cause Pain in the Eyes?
Once diagnosed, your doctor can prescribe a course of treatment that brings trigeminal neuralgia relief.
Neil H. Raskin, MD, FAAN, responds:
No. Trigeminal neuralgia (TN), a chronic pain condition caused by pressure on the trigeminal nerve, does not trigger pain directly in the eye itself. It can, however, cause pain around the eye. The trigeminal nerve has three branches—the ophthalmic, the maxillary, and the mandibular. Each conducts sensations, respectively, from the upper, middle, and lower portions of the face to the brain. If TN affects the ophthalmic branch, it can trigger sudden, sporadic, shock-like pain around the eye. Sensations caused by TN can last a few seconds to several minutes, usually occurring on one side of the face, often around the cheek, the lower part of the face, and, as mentioned, the eye.
Common Causes The condition usually occurs when a blood vessel puts pressure on or compresses the trigeminal nerve, damaging or eroding the protective coating (the myelin sheath) around the nerve, causing pain. Aging or disorders like multiple sclerosis that damage the myelin sheath or inflame the trigeminal nerve can trigger TN.
Diagnostic Process Physicians diagnose TN based on the patient's history and description of symptoms—and after ruling out other disorders such as post-herpetic neuralgia (nerve pain due to shingles), cluster headaches, and temporomandibular joint pain (pain in the jaw joint). It's important to get the correct diagnosis as treatment differs depending on the cause for the pain. FACIALPAINRELIEF.COM
Treatment Options People with trigeminal neuralgia are typically prescribed antiseizure drugs such as carbamazepine (Tegretol) and oxcarbazepine (Trileptal). If the pain spreads or becomes more intense, physicians may consider increasing the dose of these medications.
In general, over-the-counter painkillers like ibuprofen (Advil) or acetaminophen (Tylenol) and prescription opioids are not helpful for the sharp, stabbing pain of TN.
Surgery to block or resect the nerve is another treatment option. Surgery and medication both have risks and benefits, however, so it's important to discuss all your options with your neurologist.
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Dr. Raskin, a Fellow of the American Academy of Neurology, is a neurologist and headache specialist in the neurology clinic and the trigeminal neuralgia clinic at the University of California, San Francisco Medical Center.