Trigeminal Neuralgia
Also known as: Tic Douloureux,
which is French for painful twitch
What is it?
Trigeminal neuralgia is a disorder of the
trigeminal nerve, the 5th cranial nerve that
carries sensations of touch, pain, pressure, and
temperature from the face to the brain.
People with trigeminal neuralgia experience
episodes of sharp, piercing pain that can affect
the cheek, lips, gums, or chin on one side of the
face.
Who gets it?
Trigeminal neuralgia usually occurs after the
age of 70 and is unusual in anyone under the age
of 50. It affects women three times more
frequently than men. This condition may also
occur in younger people with multiple sclerosis.
What causes it?
Doctors are not exactly sure what causes this
disorder, but believe it could be the degeneration
or irritation of the trigeminal nerve. Some
believe the pain occurs when an abnormally formed
artery puts pressure on the nerve. The
trigeminal nerve is divided into three branches
and is responsible for chewing, producing saliva
and tears, and sending facial sensations to the
brain. Doctors can tell which branch
is affected by the location of the pain. Neuralgia
of the first branch causes pain around the eyes
and over the forehead. Neuralgia of the second
branch causes pain in the upper lip, nose, and
cheek. Neuralgia of the third branch causes
pain on the side of the tongue and lower lip.
What are the symptoms?
Trigeminal neuralgia is characterized by pain
that occurs suddenly and spontaneously.
People describe this excruciating pain as feeling
like an electric shock. The pain is usually
so severe that it prevents the person from doing
anything else during an attack. Pain usually
begins from the same area of the face each time,
often in the cheek next to the nose or in the jaw
area. Pain is more severe at the ends of the
affected nerve, especially over the nostrils, lip,
chin, or teeth. Often, the pain is triggered
by touching a certain spot on the face, such as
when washing or shaving, or even by activities
such as eating, drinking, or talking. At
first, the episodes of pain are brief and it could
be weeks before another attack. They could
come and go for days, weeks, or months at a time,
and then disappear altogether for months or even
years. With time, however, the episodes
occur more frequently and become even more
painful. In some people, the pain occurs as
much as 100 times a day. In these cases,
trigeminal neuralgia can cause people to limit
their activities because they are so fearful of
another attack.
How is it diagnosed?
There is no specific test for trigeminal
neuralgia, but its symptoms are so specific that
it is easy to diagnose. Your doctor will
first evaluate other possible causes of facial
pain, such as problems with the jaw, teeth, or
sinuses. He or she will also check whether a
tumor or aneurysm is putting pressure on the
trigeminal nerve.
What is the treatment?
Typical pain medications may not be effective
with trigeminal neuralgia because the pain is
brief and does not occur at regular, predictable
intervals. Antiseizure drugs, such as
carbamazepine and phenytoin, are often used to
suppress pain because they slow down the nerve
signals at certain nerve terminals. Because these
types of drugs can cause a number of different
side effects, your doctor will monitor your dosage
carefully and may need to try different types of
drugs to control the discomfort. The
symptoms usually return, however, when medication
is stopped. In cases where drug treatment is
not effective, the nerve can be deadened with
gamma rays, radio frequency waves, or glycerol
injections. The nerve can also be cut or
permanently destroyed. This type of
treatment, however, can leave lasting facial
discomfort and is only used in severe cases.
If trigeminal neuralgia is caused by an artery or
tumor compressing the nerve, surgery may be needed
to free the nerve from the source of pressure and
permanently relieve the pain. Your doctor should
make sure you are aware of all the risks and
possible complications associated with any
surgical treatment.
Self-care tips
Although there is no way to prevent trigeminal
neuralgia, you can take steps to avoid attacks if
you know what triggers them. For example,
avoid very cold or very hot food and drinks, don't
chew your food on the side that is painful, donŐt
eat extremely hard or crunchy foods, avoid
splashing your face with very hot or cold water
when washing, and rinse your mouth with water
after every meal instead of using a toothbrush.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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