A toothache no dentist could explain, and the procedure relieving years of agony

In August 2020, when Tom Murray suddenly started to experience a piercing pain in a tooth on the right side of his face, naturally, he turned to his dentist. She took X-rays, ground down the painful tooth, and prescribed pain medication, but nothing brought relief. In fact, the pain worsened. Murray described it as a “burning sensation” that flared for about 20 seconds at a time, growing more intense by the day

Suspecting he might need a root canal, the dentist referred the Newtown Square, Pennsylvania man to an endodontist. But the specialist didn’t see any reason for the procedure. A week passed, the pain persisted, and desperate for answers, Murray sought out a second endodontist and insisted on having a root canal done.

The day after the procedure, his pain returned.

At his wit’s end, Murray turned to an oral surgeon and asked to have the tooth pulled. The surgeon was willing, but warned that removing the tooth wouldn’t solve the problem. Once the anesthetic wore off, he said the pain would return.

However, the surgeon did offer a possible explanation. He suspected the problem wasn’t dental at all. Instead, he believed Murray was suffering from trigeminal neuralgia, a neurological disorder that causes sudden, severe facial pain. The condition affects the trigeminal nerve, which transmits sensory signals from the face to the brain. Even a light touch can trigger a painful jolt, though the attacks are often unpredictable. For Murray, simple acts like eating or brushing his teeth became unbearable, setting off waves of debilitating pain.

He shared the oral surgeon’s theory with his primary care doctor. The doctor explained that if it was trigeminal neuralgia, they could confirm the diagnosis by trying carbamazepine, an anti-epileptic drug known to relieve symptoms of the condition.

Shortly after his first dose, Murray's pain vanished.

But this reprieve was only the beginning of a long, grueling journey—one that would eventually lead him to a specialist uniquely equipped to help: Penn Medicine neurosurgeon John Y. K. Lee, MD, MSCE. 

Getting ahead of the pain  

Murray continued taking carbamazepine—one 300 milligram pill a day—for the next six months. Then, a neurologist he had started seeing shortly after his diagnosis began to wean him off the medication. By that point, his trigeminal neuralgia seemed to be in remission, though the neurologist was cautious, admitting she couldn’t predict how long the relief would last.

The condition remains somewhat of a mystery. Doctors can’t say with certainty why the pain sometimes recedes, or why it returns.

An MRI revealed that a blood vessel was pressing against Murray's trigeminal nerve, causing it to become hypersensitive. At 70 years of age, he had never experienced pain in his tooth or surrounding area before the summer of 2020. He had also never had any nerve-related pain elsewhere in his body. An avid runner, he was otherwise in good health.

After his initial period of relief, Murray cautiously returned to his usual routine. Just as the excruciating pain in his tooth was fading into memory, it came back—nearly a year to the day after he’d stopped the carbamazepine.

His neurologist quickly resumed his medication, but this time, it wasn’t helping. Over the next few weeks, she increased his dose to 10 times the original amount. Still, the pain didn’t subside.

Next, she tried a different drug—oxcarbazepine—and had Murray undergo blood tests, since carbamazepine can lower sodium levels. Sure enough, his sodium had plummeted. Murray ended up spending a weekend in the hospital receiving a sodium drip.

While in the hospital, another neurologist took him off all medications. When the pain inevitably returned, he recommended a new drug: gabapentin.

“It was a miracle,” Murray recalled. “I took three pills a day, every eight hours—a fairly low dose—and the pain essentially disappeared.”

Within two weeks of starting gabapentin, his pain was completely gone, and it remained that way even as his neurologist gradually reduced his dose to just one pill a day.

Despite this relief, Murray couldn’t shake the feeling that his peace wouldn’t last. After doing some online research, he learned about a surgery called microvascular decompression, considered the gold standard for treating trigeminal neuralgia.

Determined to find the best possible outcome, he began meeting with neurosurgeons across the Mid-Atlantic region.

“I didn’t really want to go outside the area if I could avoid it,” he said. “More importantly, I wanted to find the person who had the best track record with this surgery at the highest frequency.”

That search eventually led him to Dr. Jon Y. K. Lee.

Pinpointing the (microscopic) problem 

According to a pivotal study, the success of microvascular decompression largely depends on accurately identifying the exact point where the trigeminal nerve is compressed. While advances in microsurgery have made this task easier, in a 2020 study researchers noted that it remains a challenge, especially when the compression occurs near the front of the nerve.

The use of an endoscope has revolutionized this procedure. Offering panoramic views and bright lighting, it significantly improves visibility during surgery. However, due to its high degree of difficulty, Lee noted that relatively few neurosurgeons perform the procedure this way. He is part of a select group, having completed nearly a thousand endoscopic microvascular decompressions over his more than 18 years at Penn Medicine.

Lee views his work as part of a proud tradition that began with Charles Harrison Frazier, the chairman of the Department of Surgery at the University of Pennsylvania from 1922 to 1936. Frazier developed a surgical technique to alleviate the pain of trigeminal neuralgia, a method that has since evolved into the modern practice.

When Murray met with Lee in May 2022, the doctor advised him to continue with the gabapentin as long as it kept the pain at bay. Lee emphasized that he would only consider surgical intervention if medication was no longer effective. If that happened, Murray was to come back and see him.

“I was really impressed by his knowledge and his demeanor,” Murray said.

Murray went into remission again that September. As a precaution, he set a reminder for himself to check in exactly one year later. Sure enough, on September 1, 2023, the pain returned.

He immediately resumed the gabapentin, but, like the carbamazepine, it had no effect this time. Ten days after the first wave of intense pain, Tom experienced an entirely new level of discomfort. The jolts now came in regular intervals, something he had never experienced before.

He was left writhing on the floor.

Microvascular decompression surgery at Pennsylvania Hospital

Murray saw Lee shortly afterward and underwent an endoscopic microvascular decompression a week later at Pennsylvania Hospital.

When he awoke from the anesthesia, his pain was gone. The entire process couldn’t have been smoother. 

“I’ve had several surgeries, some of them pretty significant, and this was the best experience of them all,” he said. “Everyone was pleasant and engaging, and there were no issues.” 

The surgery requires an average hospital stay of two days, but Murray was back home a little more than 24 hours later.  

Lee, who serves as the director of Skull Base Surgery at Penn Medicine and medical director of Penn’s Gamma Knife Center, explained that while alternative treatments like Gamma Knife and radiofrequency thermal lesioning were options, they were “more aggressive than I wanted to be in the beginning, especially if there’s a chance for a cure.” Both of these procedures intentionally damage the trigeminal nerve.

By contrast, once the area where the nerve is compressed is identified during the less-invasive microvascular decompression, the blood vessel is moved away from the nerve and a tiny piece of Teflon felt padding is placed between the blood vessel and nerve. 

Of the three treatments, Lee explained that microvascular decompression offers the best chance for long-term pain relief and the possibility of staying off medication altogether.

Regaining his stride 

At the height of the pain, Murray couldn’t eat. He lost 35 pounds from his already lean frame. He also distanced himself from his family, including his three young grandsons. Nancy, his wife of 45 years, did everything she could to support him, but often felt powerless. Murray's life—and by extension, Nancy’s—had been reduced to episodes of excruciating pain, punctuated by the anxious moments of waiting for the next flare-up.

“It was all just so random,” he said. “It was a constant surprise attack.” 

Three months after his procedure, Murray remained pain- and medication-free, optimistic he would stay that way.

He had a little numbness in the area where there was once only blinding pain, and with that, some loss in taste. Lee said both may resolve naturally over time.  

Feeling more like his normal self, Murray is making up for lost time with Nancy, their two daughters, and grandchildren. 

He followed up with his new Penn Medicine neurologist, Seniha Nur Ozudogru, MD, who reassured him that she’s there if he needs her. Otherwise, they planned to check in yearly to help ensure Murray remains in good health.

Murray ran his first mile in months—a significant milestone, especially after associating his trigeminal neuralgia pain with running, among other things. He admits that getting back into his stride is more of a mental challenge than a physical one at this point, but he’s confident he’ll get there.