Trigeminal neuralgia, often dubbed ‘tic douloureux’, is a rare cause of facial pain. The overall prevalence of this medical condition is around 0.07%. This pain is often described as short-term, sharp and intense, and episodic in character.
It is mostly felt unilaterally and typically occurs in the regions of the face innervated by the fifth cranial nerve (or trigeminal nerve): the lower half of the face and jaws. The pain is said to be severely excruciating and is always paroxysmal in nature.
The overall frequency of painful occurrences is highly variable, ranging from 0 to 50 episodes per day, with painful symptoms often set off by minor stimuli such as jaw movements during eating/drinking, shaving, or even touching one’s own face. Occasionally the pain is severe enough for the patient to correlate it with receiving an electric shock.
Chillies as relief from trigeminal neuralgia pain?
In 2019, following surgery on my jaw, I developed temporary trigeminal neuralgia. For nearly 3 days post-surgery, I was surprisingly pain-free. On the third day, the pain struck like a lightning bolt. It was mind-blowingly bad.
Now, as a former neuro nurse, I was familiar with TGN patients and their pain levels, but I guess I could never have really understood how severe they were.
Fortunately, I had been soaking some super-hot chillies in olive oil for some months, and I knew from the research that I should apply the oil to the affected area of my face. The relief came within a minute and lasted for some hours.
So this chilli oil in combination with CBD oil (consumed orally) made an effective treatment for the pain for the following month or so while I suffered the trigeminal neuralgia episodes.
While chillies are well known to relieve pain, they fail to treat the underlying cause.
Chilli for therapy of trigeminus neuralgia. A case report
The symptoms of trigeminal neuralgia tend to occur repetitively over a period of weeks or even months, and these episodes may be followed by pain-free intervals. A majority of cases occur secondary to mechanical compression of the trigeminal nerve, particularly at the point where it arises from the brainstem. The compression is mostly due to localised vascular abnormalities. Still, however, some patients with trigeminal neuralgia might be diagnosed with an underlying demyelinating disorder such as multiple sclerosis. A few patients might also present with a deeply rooted malignancy, including brain tumours such as meningiomas.
To diagnose such complicated cases, it is essential to perform a brain imaging study such as an MRI (magnetic resonance imaging) or CT (computed tomography) scan. Otherwise, most medical experts emphasise that the diagnosis of trigeminal neuralgia should be largely based on the patient’s clinical presentation.
The management of trigeminal neuralgia is initially carried out through a conservative approach. Anti-epileptic medications are the crux of pharmacotherapy, where carbamazepine/oxcarbazepine is the most preferred treatment option.
For some patients, an additional drug (e.g., gabapentin) might be used if facial pain is not fully relieved. Perhaps the most effective treatment strategy for trigeminal neuralgia is surgical intervention, which may be carried out via the following approaches:
- Open surgical decompression; performed by removal of the vascular anomaly.
- Destruction of the nerve root via a percutaneous approach (glycerol rhizotomy).
- Radiological lesioning of the nerve root (stereotactic radiofrequency rhizotomy). Gamma Knife and CyberKnife are two modern interventions utilised for this procedure.
It has been observed that surgical intervention is followed by long-term medical therapy in a majority of cases.
It is noteworthy that finding a sound aetiology for trigeminal neuralgia is a major step in its clinical management. If necessary, imaging scans should be performed, and targeted therapy must be initiated to provide immediate pain relief for this agonising condition.