Pain Management Part 1 – Neurology

For many people, pain is a constant companion. At The Capstone Clinic, we treat many people who have been living with pain in the facial and ENT regions. Being a multi-speciality family health clinic, we are able to address pain in a holistic manner, thereby aiding in pain alleviation. In many instances, the pain could have reduced or eliminated with a better understanding of contributing conditions and treating the same. Unfortunately, many seek only short-term relief without due root cause analysis and hence are stunned when we are able to treat them effectively. Here is part one of our three-part blog series on Pain Management, linking many facial pain issues to neurological factors.  

Facial Pain and Nerves:

Trigeminal nerve is a nerve which provides sensations in the face and helps in functions such as chewing and biting. A neuropathic condition called trigeminal neuralgia is one where irritation of the trigeminal nerve results in severe facial pain.

Common cause for trigeminal nerve is a vascular loop, a small blood vessel which presses on the trigeminal nerve as it emerges from the brain. When there are blood vessels coursing through the brain, sometimes they can press on the nerve and produce severe pain.

Usually, such patients have extreme cases of pain which almost blinds them and puts them in an electric shock-like state. This is often triggered by any facial movement caused by the trigeminal nerve, including eating, brushing, gargling, talking, etc. There

fore, any facial movement will stimulate the trigeminal nerve and cause severe pain. This will strictly be one-sided pain, either the left, right, upper or lower parts of the face.

The diagnosis is done using a special MRI scan, where the focus is on the brain stem to see whether this compression is by the vascular loop.

Initial treatment is given through medicines which reduce neuro pain. There are several drugs for this, the most common one being carbamazepine, but patients, who do not respond to such drugs, need other forms of treatment. One form of treatment is radiofrequency ablation, where an electrical current through a radio wave, helps in reducing the pain signals in that specific nerve region. Another form of treatment is surgery called microvascular decompression. What happens is that a patch of teflon is placed between the artery and the nerve so that it doesn’t irritate the nerve whenever the nerve pulsates, thereby, relieving the pain.

Cluster Headaches:

Another condition called cluster headache affects the upper part of the face, i.e. mainly in the eye orbit and the forehead. Usually these are the areas where severe pain is found in individuals. It is also called suicide headache, as the pain is so extreme, that many may even think of committing suicide as they are blinded by the pain extremes. This pain could last for an hour to a couple of hours – almost 

once or two-three times a day. It occurs in clusters, lasting for a couple of months, after which they may be free for some months or even years. This kind of pain responds only to few drugs. Many times, this pain is not taken seriously. For example, there are many patients who are going around with a diagnosis of ordinary headache, even though they may be suffering from cluster headache. They are given treatments which do not help, as even painkillers do not help. So, a specific drug needs to be given for cluster headache which is called verapamil.

These are the two headaches when you have facial pain – cluster headache and trigeminal neuralgia which require specific diagnosis and treatment. It is important to differentiate these from common headaches such as Migraine and Tension Headache.

Other conditions causing facial pain:

In addition, there are many other causes of facial pain, such as sinus, tooth-related dental pain, temporomandibular joint disorder (TMD). TMD is something that can be better explained by our dental specialists at The Capstone Clinic. We refer our patients to a dental surgeon or maxillofacial surgeon to eliminate TMD as a possibility for causing facial pain.

Our advice to families is to consult one of our experts when they find a family member suffering from any kind of unexplained pain. The right diagnosis could lead to the right treatment and a pain-free life.

Watch this space for part two in this series, where our dental experts will throw more light on pain that can be reduced through dental treatments.