Facial pain on only one side can be due to a variety of causes. One of these is trigeminal neuralgia. Patients with trigeminal neuralgia describe the pain as stabbing and intense, and given that this pain can be triggered easily by common gestures such as chewing or simply touching the face, it can become a highly disabling condition. The good news is that there are effective treatments for relieving this pain.
Pain on only one side of the face can be a symptom of trigeminal neuralgia.
This condition occurs when the trigeminal nerve, which sends signals back and forth from the face to the brain, is damaged or irritated.
Abnormal pressure on the nerve can cause it to malfunction, leading to intense facial pain.
Trigeminal neuralgia is more common in women than men, and is more common in people over 50.
Pain in the cheek or jaw as a symptom of trigeminal neuralgia
Maxillary pain (upper jaw) or mandibular pain (lower jaw) is a symptom that may be due to several different conditions.
Among the most common conditions are: temporomandibular joint disorders, dental problems (cavities, abscesses, etc.), headaches, muscle tension in the neck area, and sinusitis.
In order to diagnose trigeminal neuralgia as the cause of pain on one side of the face, these conditions must first be ruled out.
Even so, pain due to trigeminal neuralgia usually has very tell-tale characteristics, which are good clues to the presence of this condition.
Trigeminal neuralgia tends to manifest itself with as very intense, stabbing pain, which appears suddenly and sporadically in this part of the face.
Patients tend to describe it as feeling like an electric shock, or severe throbbing pain, and it can be accompanied by facial spasms.
These episodes can last from a few seconds to a few minutes. They can also occur in quick, repeated series, over a period of up to two hours.
The pain is usually focused on one side of the face, usually in the area of the upper or lower jaw. However, the trigeminal nerve is connected to other areas, and the pain can extend to these areas as well.
Among these are the chin, nose, and cheeks. The eyes and forehead may also be affected, although this is not as common.
Episodes of trigeminal nerve pain are usually triggered by ordinary daily actions. For example, talking, laughing, chewing, swallowing, touching or washing the face, brushing your teeth, shaving, or putting on makeup. Sometimes, the pain can even be triggered by the wind blowing on your face.
As it is such an intense and easily triggered pain, it usually has a very negative impact the patient’s quality of life. Especially when the attacks of pain occur several times a day, or when the attacks last for days, weeks, or even months. To make matters worse, these episodes of pain tend to become more frequent and intense over time. So much so, that some patients come to dread the simple act of eating or drinking out of fear that it will trigger an attack. Unfortunately, trigeminal neuralgia is not easy to treat with medication alone, and it has even been associated with an increase in the suicide rate.
Unlike other types of facial pain, this one rarely affects the patient while sleeping. It usually does not affect both sides of the face, and it does not lead to numbness or loss of touch in the affected area.
Why is the pain only on one side?
In trigeminal neuralgia, there is usually jaw pain on only one side. The pain may spread to other areas (chin, cheekbones, etc.), but on that same side of the face.
The pain might be on the right jaw or the left jaw, but it is rare for it to occur on both sides at the same time, because the compression or damage to the trigeminal nerve usually occurs in only one of its branches
When it does occur on both sides, the condition is known as bilateral trigeminal neuralgia (which usually implies an underlying neurological disease).
Causes of jaw pain due to trigeminal neuralgia
Compression by a blood vessel
This is the most common cause of trigeminal neuralgia.
It occurs when a blood vessel (artery or vein) comes into contact with the trigeminal nerve at the base of the brain.
This contact presses on the nerve, irritating it and not allowing it to function properly. Some anatomical variations or abnormalities in the brain and certain vascular malformations can also compress the trigeminal nerve and cause pain.
In these cases, microvascular decompression surgery, performed by expert neurosurgeons, has proven to be highly successful in giving patients complete relief from the pain, with no need for medication once they have undergone the procedure. This surgery is very safe, has excellent results, and allows the patient to have a quick recovery and an improved quality of life.
Herpes-Zoster Virus
In cases where someone suffers is a reactivation of the chickenpox virus, it may lead to what is known as post-herpetic neuralgia can appear. It affects up to 15% of patients. Timely treatment of the infection with antiviral medication considerably reduces the risk of post-herpetic neuralgia.
In the case of trigeminal nerve involvement, it is usually not bilateral. That is, it tends to produce jaw pain on only one side. It requires pharmacological treatment and, in advanced cases, treatments directed at the nerve to achieve pain relief (such as a neurosurgical procedure).
Multiple sclerosis
Trigeminal neuralgia can occur when multiple sclerosis causes lesions in the white matter of the brain adjacent to the sensory nuclei of the trigeminal nerve, in the brainstem (the most rudimentary and important part, controlling the brain's vital functions). In these cases, the patient may even suffer bilateral trigeminal neuralgia, caused by continuity of the lesions.
Tumor
In rare occasions, trigeminal neuralgia is due to compression by a brain tumor somewhere between the point where the nerve emerges from the brain and where it exits from the cranial vault.
Lesion
Any lesion to the trigeminal nerve from surgery, a stroke, or an injury can provoke neuropathic facial pain.
To determine the cause of neuropathic facial pain, it is common to do an MRI of the brain, using specific sequences to see the area where the trigeminal nerve emerges.
This diagnostic test makes it possible to see if there is damage to the nerve, if there is a tumor, or if there are signs of other diseases.
Treatment for trigeminal neuralgia
Once the cause of jaw pain on one side of the face is determined, the recommended treatment will vary depending on the cause, how advanced the condition is, and the particular details of each patient’s case.
Medication
Medication is usually the first treatment of choice for trigeminal neuralgia, specifically anti-seizure medications such as carbamazepine.
If this medication is not successful in controlling the patient’s pain, there are other therapeutic options. More and more, in selected cases, the preference is to proceed to microvascular decompression surgery as a means of providing permanent relief from the nerve pain.
Microvascular decompression
At Instituto Clavel, microvascular decompression is our first-choice treatment technique for trigeminal nerve pain that cannot be controlled with medication.
This is a widely accepted, permanent surgery with a high success rate in protecting against recurrence of pain in the long term.
Microvascular decompression, as its name suggests, reduces the pressure on the trigeminal nerve by eliminating the pressure from any artery of vein that is pressing on the nerve.
It is the treatment of choice for classic neuralgia.
The procedure consists of making a small opening in the skull and inserting a small amount of protective material between the blood vessel and the nerve, or using a technique to separate the blood vessel from the nerve. The incision is made behind the ear, once healed, is hardly noticeable.
As a result of this operation, the nerve is released and decompressed, ending the patient’s pain almost immediately.
Other procedures
There are other types of treatments for trigeminal neuralgia.
These treatments may be considered in cases in which microvascular decompression is not recommended. For example, if the patient’s age or other circumstances suggest an unfavorable result of microvascular decompression.
This applies also when the nerve pain is caused by something else, as in the case of post-herpetic neuralgia.
The main alternative techniques used for these cases are trigeminal radiofrequency and balloon compression of the Gasser ganglion.
Both percutaneous techniques are performed through a puncture at the base of the skull, with radiological guidance or intraoperative neurophysiological monitoring to identify the point where the nerve exits the skull.
Although these procedures can provide significant relief from neuropathic facial pain, they are not as effective in the long term as microvascular decompression.
Instituto Clavel, specialists in trigeminal neuralgia
At Instituto Clavel we have a team of neurosurgeons who are experts in the treatment of facial pain due to trigeminal neuralgia.
This means that we have a very high success rate at all stages of the procedures.
What’s more, our approach to patient care includes a personalized program to accompany the patient throughout the process and help achieve a faster recovery.
We encourage you to read about it our program here: Preparation, Empowerment, and Recovery (PER).
We hope this article has answered your questions about the nature and causes of facial pain when it occurs on only one side, and ways to relieve it.
If you have any further questions, or would like to make an appointment with one of our specialist physicians, please don’t hesitate to contact us.
Dr. Guillermo Montes Graciano
Neurosurgeon and Medical Director of IC Barcelona
Specialist in brain oncology surgery and cervical and lumbar arthroplasty
Dra. Gloria Villalba Martínez
Collaborating neurosurgeon
Specialist in craneofacial pain
Dr. Pablo Clavel Laria
Neurosurgeon and Director of the Instituto Clavel
Specialist in general spine surgery, lumbar anterior approach, cervical microdiscectomy, robotic surgery, neuronavigation and brain tumor surgery
Categories: Prevention, Techniques, Pain Management