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A pain to the patient and to the doctor
  1. Pedro C Brás,
  2. Sara P Dias
  1. Department of Neurology, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
  1. Correspondence to Dr Pedro C Brás, Department of Neurology, Centro Hospitalar de Lisboa Central, Lisbon 1169-050, Portugal; pedrocostabras{at}gmail.com

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In the summer of 2017, I (PCB) was a fourth-year neurology resident with an interest in epilepsy working in Lisbon. I had recently started swimming, and while diving under water I began to have episodes of brief, shock-like pain inside my right jaw, each lasting less than 1 s. The pain was located near my inferior molar teeth, although I could not pinpoint the exact tooth it came from. Later more everyday actions as toothbrushing, talking or smiling could trigger the pain, so it was impossible to avoid.

With time, these episodes increased in frequency and intensity. A month later, the same innocuous stimulus would precipitate more severe episodes of lancinating paroxysmal pain lasting up to 2 min and radiating from my right jaw to the ipsilateral cheek and forehead. They stopped abruptly and were followed by a refractory period during which pain could not be triggered. This was the worst pain I had ever experienced.

As a neurologist, I quickly suspected I had trigeminal neuralgia. As a patient, however, I convinced myself there must be …

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