Behind the blockbuster smile and unstoppable swagger, Bollywood’s Bhai, Salman Khan, has silently battled one of the most agonizing medical conditions known to mankind—trigeminal neuralgia. Dubbed the “suicide disease” for its unbearable, lightning-like facial pain, this rare nerve disorder has brought even the strongest to their knees. His candid revelations about the condition—often described as “worse than childbirth” or “like being electrocuted in the face”—shed light on a struggle few can imagine.
If it can bring a man who shrugs off action-hero injuries to his knees… what does it do to ordinary people? Let’s break down the terrifying truth about trigeminal neuralgia—and why Salman Khan’s story is a wake-up call for us all.
What is trigeminal neuralgia?
Trigeminal Neuralgia (TN), also known as tic douloureux, is a chronic pain disorder affecting the trigeminal nerve (the fifth cranial nerve), which carries sensation from the face to the brain. It is characterized by sudden, severe, electric shock-like facial pain, typically on one side of the jaw, cheek, or forehead.
The pain is often triggered by routine activities like chewing, speaking, brushing teeth, or even a light touch. Due to its excruciating intensity, TN is sometimes referred to as the “Suicide Disease”, as the relentless pain can severely impact a patient’s quality of life.
Causes of Trigeminal Neuralgia
- Compression of the Trigeminal Nerve (Most Common Cause)
- Usually caused by a blood vessel (artery or vein) pressing on the nerve near the brainstem.
- This leads to nerve irritation and misfiring, causing sudden, severe pain.
- Nerve Damage Due to Aging
- Natural wear and tear or aging can contribute to nerve compression.
- Multiple Sclerosis (MS)
- MS causes demyelination (damage to the protective nerve coating), leading to TN.
- About 1-2% of TN cases are linked to MS.
- Tumors or Lesions
- A brain tumor, cyst, or abnormal growth pressing on the trigeminal nerve can trigger TN.
- Trauma or Injury
- Facial trauma, dental procedures, or sinus surgery can damage the trigeminal nerve.
- Other Medical Conditions
- Stroke affecting the brainstem.
- Viral infections (like herpes zoster) that damage nerves.
- Arteriovenous malformations (AVMs) affecting blood vessels near the nerve.
Symptoms of Trigeminal Neuralgia
1. Sudden, Severe Facial Pain
- The hallmark symptom is intense, electric shock-like or stabbing pain in the face.
- Pain typically lasts from a few seconds to two minutes but can occur in repeated bursts.
- Often triggered by mild activities like:
- Brushing teeth
- Shaving
- Applying makeup
- Eating or drinking (especially hot, cold, or spicy foods)
- A light breeze or touch
2. Pain Location: Which Parts of the Face Are Affected?
The trigeminal nerve has three branches, and pain usually affects one side of the face:
- V1 (Ophthalmic branch) – Forehead, eye, and upper eyelid.
- V2 (Maxillary branch) – Cheek, upper lip, upper gum, and side of the nose.
- V3 (Mandibular branch) – Lower lip, lower gum, jaw, and sometimes the tongue.
Most commonly, pain occurs in the V2 and V3 regions (cheek and jaw).
3. Episodes of Pain: Unpredictable & Debilitating
- Pain can come in cycles, with periods of remission followed by flare-ups.
- Some patients experience “trigger zones”—small areas on the face that, when touched, set off an attack.
- Over time, episodes may become more frequent and severe.
4. Atypical Trigeminal Neuralgia (Less Common but More Complex)
- Some patients experience a constant burning or aching pain instead of sharp shocks.
- This form is harder to treat and may indicate nerve damage from conditions like multiple sclerosis (MS).
Trigeminal Neuralgia Diagnosis
Diagnosing trigeminal neuralgia (TN) can be challenging because there is no single test to confirm the condition. Doctors typically rely on a detailed medical history and a description of symptoms, such as sudden, sharp, electric shock-like facial pain triggered by everyday activities like eating or brushing teeth. A neurological exam helps assess nerve function and identify sensitive trigger points. To rule out other conditions—such as dental problems, migraines, or multiple sclerosis—imaging tests like an MRI scan are often used. An MRI can detect potential causes, such as blood vessel compression or tumors pressing on the trigeminal nerve. In some cases, a diagnostic nerve block may be performed to confirm TN by temporarily numbing the nerve and observing if pain relief occurs.
Since TN symptoms can overlap with other disorders, accurate diagnosis requires careful evaluation. Early and precise identification is crucial to managing the condition effectively, as misdiagnosis can delay proper treatment. Both clinical assessment and advanced imaging play key roles in distinguishing TN from similar facial pain conditions. If TN is confirmed, treatment options—including medications, nerve blocks, or surgery—can then be explored based on the underlying cause.
Trigeminal Neuralgia Treatments
1. Medications (First-Line Treatment)
- Anticonvulsants:
- Carbamazepine (Tegretol) – Most commonly prescribed, effective for many patients.
- Oxcarbazepine (Trileptal) – Similar to carbamazepine, fewer side effects.
- Gabapentin (Neurontin), Pregabalin (Lyrica), Lamotrigine (Lamictal) – Alternatives if first-line drugs fail.
- Muscle Relaxants:
- Baclofen – Sometimes used in combination with anticonvulsants.
- Side Effects: Dizziness, drowsiness, liver issues (monitoring required).
2. Surgical Options (If Medications Fail or Side Effects Are Severe)
- Microvascular Decompression (MVD):
- Gold standard for TN caused by blood vessel compression on the trigeminal nerve.
- Involves placing a cushion between the nerve and compressing vessel.
- High success rate (~70-90% long-term pain relief).
- Stereotactic Radiosurgery (Gamma Knife):
- Non-invasive, uses focused radiation to damage the nerve.
- Pain relief may take weeks to months.
- Percutaneous Procedures (Less Invasive, Nerve Ablation):
- Glycerol Injection – Destroys nerve fibers.
- Balloon Compression – Compresses nerve to block pain signals.
- Radiofrequency Rhizotomy – Heat-based nerve destruction.
- Provides temporary relief (months to years).
3. Alternative & Supportive Therapies
- Nerve Blocks – Injections to numb the nerve.
- Complementary Approaches – Acupuncture, biofeedback (limited evidence).
- Lifestyle Adjustments – Soft diet, avoiding triggers (cold wind, chewing).
4. Emerging & Experimental Treatments
- Botulinum Toxin (Botox) Injections – Shows promise in some studies.
- Neuromodulation – Peripheral nerve stimulation (under research).
Takeaways
Trigeminal neuralgia is a severe and often excruciating condition that impacts the facial nerves. The pain may be persistent or occur in sudden, intermittent bursts. Diagnosing trigeminal neuralgia can be challenging initially, as its symptoms mimic other disorders—such as sinus infections, certain headaches, and even dental issues. However, effective treatments are available to manage the pain, making it crucial to consult a doctor for a proper diagnosis and personalized care plan.
