11.4 A Stab in the Face

Time To Read

3–5 minutes

Date Last Modified

Age 45


Dysautonomia

1

Multi-Organ Autonomic Dysfunction

2

‘Revved’ Flares

3

Autonomic Symptoms Track Inflammation

4

Trigeminal Neuralgia

5

Cochlear Hair-Cell Injury

6

Two Cranial Nerves Affected 

7

Dysautonomia

It started as a fluke — a jolt of pain across Stina’s cheek when a cold wind hit her at a bus stop. Then a toothbrush set it off. Then chewing. The pain was unlike anything she knew: brief, electric, savage, gone in seconds, always on one side of her face. Ordinary painkillers did nothing. A neurologist finally named it — trigeminal neuralgia — and, crucially, reached for a different class of drug entirely.

The trigeminal nerve is cranial nerve V (CN V), the great sensory nerve of the face; it carries touch, pain, and temperature from the forehead, cheek, and jaw. Trigeminal neuralgia is a disorder of that nerve in which light, ordinarily harmless touch — a breeze, a toothbrush — triggers paroxysms of severe, electric, stabbing pain. It is classically associated with irritation or demyelination of the nerve. And because the pain comes from abnormal, hyperexcitable nerve firing rather than ordinary tissue damage, it responds to anticonvulsants that calm electrical misfiring — not to the standard analgesics that target inflammation or pain receptors.

That drug choice is the tell, and so is the company the diagnosis keeps: a nervous system already shown to be inflamed and demyelinating (the Brain module) is exactly the soil in which CN V misfires. Stina’s face pain wasn’t a dental problem or a fluke — it was an inflamed, demyelinating nervous system discharging through a specific cranial nerve.

List of terms