Easing Your Mind About Pain in the Face

Q:  In 1993 I was diagnosed with tic douleureux, which I understand is a damaged facial nerve. The pain runs from my cheek to the middle of my face - my upper lip, lower lip and chin on the right side of my face. Eating and talking are very painful.

In the beginning I was treated with small dosages of Tegretol (carbamazepine), but as time went on and the pain increased, the dosage also increased. I believe I have now reached the limit of Carbamazepine since a recent dosage increase took me to the emergency room at the hospital because of side effects. Is there any other treatment or new medication for this condition? I would appreciate ANY help you can give me.

A:  Tic douleureux, also called trigeminal neuralgia, affects the trigeminal nerve, one of the largest nerves in the face. The nerve is not really damaged, but hypersensitive for some unknown reason. As you noted, it is a very painful condition with stabbing pain typically felt on one side of the face.

Treatment for trigeminal neuralgia includes anti-convulsant medications such as carbamazepine or phenytoin, but sometimes their side effects may exceed their benefits. Nerve blocks and surgery can also be tried if medications fail.

"Dear Doctor" is a compilation of patient questions answered by doctors from the Medical College of Wisconsin.