Trigeminal Neuralgia: What is this "Suicide Disease" Salman Khan is suffering from?

Have you ever noticed that it usually takes a superstar to suffer from some rare disease to make the world suddenly spring into awareness? Earlier in March, news surfaced that Bollywood superstar Salman Khan struggles with a condition that causes intense, debilitating pain—a chronic neurological disorder known as trigeminal neuralgia, often referred to as the "suicide disease."

The pain associated with this condition is so severe that it can sometimes feel almost impossible to bear. One person diagnosed with trigeminal neuralgia recalls, "You can’t live with the pain trigeminal neuralgia brings." And they’re not exaggerating.

Imagine living your life with pain that hits you out of nowhere. A sudden, sharp pain in your face, like an electric shock or a stabbing sensation, without any warning. It can come and go—sometimes it's brief, sometimes it lingers.

You might feel it in your jaw, your teeth, or your gums. You don’t know what it is about. Is it a sinus flare-up? Should you go to the dentist? Maybe it’s an allergic reaction. One moment, you’re fine, and the next, you’re gripped by a pain so intense that it can stop you in your tracks.

The uncertainty of when it will strike next, how long it will last, and how severe it will be is overwhelming. You never quite know when the pain will hit or how it will affect you.

It changes everything, and for those who experience it, it can make everyday activities like talking, eating, smiling, or even brushing your teeth feel almost impossible.

Trigeminal neuralgia, or "tic douloureux", is a sudden, severe pain. In your face. Sharp shooting pain in the jaw, teeth or gums.

It happens because of issues with the trigeminal nerve, which carries signals from your face to your brain. We have two trigeminal nerves - one for each side of our face- but trigeminal neuralgia most commonly affects only one side.

You may not want to underestimate the pain caused by trigeminal neuralgia. It is unlike any other facial pain that is caused by other reasons. The pain can be sharp and shooting, often described as a stabbing or electric shock-like sensation, most commonly felt in the jaw, teeth, or gums.

It is not life-threatening. But it is life-altering. Why? Because even simple activities like chewing or talking or smiling or brushing your teeth can be intensely painful.

The constant worry about when the next episode will come and how bad it will be adds another layer of stress for those living with the condition.

Living with trigeminal neuralgia(TN) isn’t just about managing pain—it’s about coping with uncertainty and the toll it takes on your mental and emotional well-being.

To understand the causes, we need to understand that there are three types of trigeminal neuralgia:

1. Classical

This is caused by pressure on the trigeminal nerve, which provides sensation to the face. In most cases, the pressure is caused by an artery or vein squishing the trigeminal nerve and possibly the pressure could wear away the protective outer layer (myelin sheath), which could cause the pain signals to travel along the nerve.

2. Secondary

This is when another medical condition causes trigeminal neuralgia:

• A cyst

• A tumour

• Arteriovenous malformation – an abnormal tangle of arteries and veins

• Multiple sclerosis (MS) – a long-term condition that affects the nervous system

• A facial injury

• damage caused by surgery, including dental surgery

3. Idiopathic

This term is used when the cause for TN is unknown.

Studies have found that some factors put people at increased risk of developing trigeminal neuralgia, such as:

• Sex - TN is more likely to affect women than men.

• Age - This disease affects people more over the age of 50.

• Certain health conditions - Hypertension or high blood pressure, Multiple Sclerosis or having a family history of TN.

• Smoking.

So, how do you know if you have trigeminal neuralgia? It could include one or more of these patterns:

• You may feel an intense jabbing pain that could also feel like an electric shock.

• The pain could last from a few seconds to a few minutes.

• Pain on one side of your face at a time.

• Pain that does not or rarely occurs while sleeping.

• After the shooting pain has subsided, you may feel a slight ache or a burning feeling.

• You may experience regular intervals of pain every few days or weeks or months at a time. Sometimes, the pain may completely disappear for a few months or even years. This period is called remission.

Even simple activities could be triggers for painful episodes like:

• Eating or drinking

• Touching your face

• Talking or smiling

• Brushing your teeth

• Shaving

• Putting on make up

• Washing your face

• Breeze or gust of wind on your face

Your diagnosis will depend on three things:

• Type of pain

• Location of the pain

• The triggers

Treatment usually starts with medication, and you may not need additional treatments. However, some people with the condition may need to consider surgical options.

• Medication

• Anti-seizure medicines

• Muscle relaxants

• Botox injections

• Microvascular decompression - It involves moving or removing the blood vessels that are causing pressure on the trigeminal nerve and causing the excruciating pain.

• Brain stereotactic radiosurgery or Gamma Knife - In this procedure, a focused dose of radiation is aimed at the root of the trigeminal nerve, which reduces or stop the pain.

Medication may only help temporarily, or it may stop being effective. Surgery may be a better long-term solution. However, like all procedures, there is a risk that the pain may come back after three to five years. But the good news is that if the pain returns, you can have the procedure again, so all hope is not lost!

Living with trigeminal neuralgia is no easy feat. The sudden, intense pain it causes can be incredibly isolating, making even the simplest tasks feel impossible. It’s important to understand that this isn’t just physical pain—it can affect every part of a person’s life, from their daily activities to their mental health.

By raising awareness, like Salman Khan has done, we can help bring more understanding and support to those dealing with this debilitating condition. With the right treatment and care, it’s possible to manage the pain, but having compassion and empathy for those who suffer is just as important.

Celebrities coming forward and talking about their struggles can help create awareness and acceptance. And it reminds us of an important aspect of any health concern - how important it is to talk about it.

Q. How is it diagnosed?

A. Doctors diagnose TN through a physical exam, review of medical history, and potentially imaging tests like MRI to rule out other conditions.

Q. Can it be confused with other conditions?

A. Yes, TN can be mistaken for dental problems, headaches, or other facial pain conditions.

Q. Is surgery an option?

A. Yes, surgery, such as microvascular decompression, may be considered if medications are ineffective or cause significant side effects.

Q. Is there a cure?

A. While there isn't a cure, treatment options can effectively manage and reduce the pain.

Q. What kind of medications are used?

A. Anticonvulsants, which are used to treat epilepsy, are often prescribed to help control the pain.