Trigeminal Neuralgia

December 22 21:57 2019 Print This Article

Trigeminal neuralgia, or Tic Douloureux, is a neuropathic disorder of the trigeminal nerve. The condition is characterized by pain often accompanied by a brief facial spasm or tic. The intensity of pain can be physically and mentally incapacitating. It is also known as tic douloureux, is a pain syndrome recognizable by patient history alone. TN pain is typically felt on one side of the jaw or cheek. Episodes can last for days, weeks, or months at a time and then disappear for months or years.

The most common cause of Trigeminal Neuralgia is an enlarged looping artery or vein pressing on the Trigeminal nerve at the base of the brain. Other less frequent causes are multiple sclerosis or a brain tumor, both of which can usually be identified by MRI scan when they exist. Trigeminal neuralgia is considered by many to be among the most painful of conditions and has been labeled the suicide disease, due to the significant numbers of people taking their own lives because they were unable to have their pain controlled with medications or surgery.

Trigeminal neuralgia (TN) is paroxysmal triggered face pain. By many, it’s called the “suicide disease”. One theory suggests that peripheral injury or disease of the trigeminal nerve increases afferent firing in the nerve; failure of central inhibitory mechanisms may be involved as well. A less common form of the disorder called “Atypical Trigeminal Neuralgia” may cause less intense, constant, dull burning or aching pain, sometimes with occasional electric shock-like stabs.

Once the initial pain is controlled it is important to consider the natural history of Trigeminal Neuralgia in order to understand long term management. Most patients respond very well to radiosurgery with the Gamma Knife, which is one of the best standard treatments for this condition.New cases of trigeminal neuralgia affect 4 to 5 out of every 100,000 people in the United States each year. The initial treatment for Trigeminal Neuralgia should be medical.

Causes of Trigeminal Neuralgia

The comman causes of Trigeminal Neuralgia include the following:

  • The presumed cause of TN is a blood vessel pressing on the trigeminal nerve as it exits the brainstem.
  • Others believe the cause stems from biochemical change in the nerve tissue itself.
  • Certain factors – such as physical nerve damage and stress – can trigger the beginning of the painful attacks.
  • Paraneoplastic (possibly).
  • The cause of trigeminal neuralgia is not completely understood, but it is generally considered to be due to blood vessels pressing on the root of the trigeminal nerve, where the nerve leaves the brain.
  • A more recent notion is that an abnormal blood vessel compresses the nerve as it exits from the brain itself.

Symptoms of Trigeminal Neuralgia

Some sign and symptoms related to Trigeminal Neuralgia are as follows:

  • The pain is lightninglike and hardly lasts for longer than a second.
  • Pain during chewing, eating, drinking, shaving, or brushing teeth.
  • A light touch or vibration is the most effective trigger.
  • Lightning-like or electric-shock-like.
  • Very painful, sharp electric-like spasms last a few seconds to minutes.
  • TN is characterized by a sudden, severe, electric shock-like, stabbing pain that is typically felt on one side of the jaw or cheek.
  • Increased sensitivity of the skin or numbness of the affected skin area (feeling similar to a local anesthetic such as a Novacaine shot)
  • Like having live wires in your face.
  • Common sensations such as having wind hit your face.

Treatment of Trigeminal Neuralgia

Here is list of the methods for treating Trigeminal Neuralgia:

  • Anticonvulsant medicines used to block nerve firing are generally effective in treating TN.  These drugs include carbamazepine, oxcarbazepine, topiramate, clonazepam, phenytoin, lamotrigin, and valproic acid.
  • The goal of pharmacologic therapy is to reduce pain.
  • Narcotic analgesics such as codeine may be needed for a short time to control severe pain.
  • Coordinate therapy for refractory pain of TN with the primary care physician or consultants.
  • Tricyclic antidepressants such as amitriptyline, nortriptyline, or carbamazepine.
  • Injection techniques also can relieve unremitting pain instantly and further confirm the diagnosis.
  • Antidepressant medications, such as amitryptiline, may be helpful to control pain in some cases. The topical (local) application of creams containing capsaicin also may help to control pain.
  • Physical therapy may be helpful for some types of neuralgia.
  • Some patients may require surgery.