Trigeminal Neuralgia
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What is Trigeminal Neuralgia?
Trigeminal neuralgia (TN), tic douloureux (also known as prosopalgia, the Suicide Disease or Fothergill’s disease) is a neuropathic disorder characterized by episodes of intense pain in the face, originating from the trigeminal nerve. One, two, or all three branches of the nerve may be affected. It is, "one of the most painful conditions known to humans, yet remains an enigma to many health professionals." This pain may be felt in the ear, eye, lips, nose, scalp, forehead, cheeks, teeth, and/or jaw and side of the face; some patients also experience pain in their left index finger. Trigeminal neuralgia (TN) is not easily controlled and there is no cure. It is estimated that 1 in 15,000 people suffer from trigeminal neuralgia, although the actual figure may be significantly higher due to frequent misdiagnosis. In a majority of cases, TN symptoms begin appearing after the age of 50, although there have been cases with patients being as young as three years of age. It is more common in females than males.
What causes Trigeminal Neuralgia?
Trigeminal neuralgia can be caused by a blood vessel pressing against the nerve, or by demyelination in patients with MS. Infrequently, it may be caused by a growth in the back of the skull. In some patients, no cause can be found.
What are typical symptoms?
Very painful, sharp, electric-like jolts of pain that last a few seconds or minutes. Pain is only on one side of the face, usually around the eye, cheek, lips, and lower part of the face. Pain may be triggered by:
- Brushing your teeth or hair
- Chewing, drinking, or eating
- Shaving, washing, or wind
What tests are used?
Magnetic resonance imaging (MRI) is the most common test used to help rule out other conditions. In some patients, a vessel is seen pressing against the trigeminal nerve.
What treatments are available?
Certain medication can help reduce the pain and the rate of attacks, in particular antiepileptic drugs (carbamazepine or oxcarbazepine, gabapentin, phenytoin) or baclofen. When symptoms do not respond enough to medical therapy, surgery can help, including: