Trigeminal neuralgia is an extremely painful inflammation of the
trigeminal nerve which causes severe lightening-like facial pain and spasm of the facial
muscles on the involved side.
These painful attacks may occur after lightly touching different skin areas of the
face, along the course of this cranial nerve. Specific medications can be very effective
in reducing the rate of attacks, but surgical intervention may be necessary
Trigeminal neuralgia is a disorder of the trigeminal nerve (the fifth cranial nerve)
that causes episodes of sharp, stabbing pain in the cheek, lips, gums, or chin on one side
of the face.
Information about Trigeminal Neuralgia
Trigeminal neuralgia, also known as tic douloureux, is a painful disorder
of a nerve in the face called the trigeminal nerve or fifth cranial nerve. There are two
trigeminal nerves, one on each side of the face. They are responsible for detecting touch,
pain, temperature and pressure sensations in areas of the face between the jaw and
People who have trigeminal neuralgia typically experience episodes of
sudden, intense, "stabbing" or "shocklike" facial pain. This pain can
occur almost anywhere between the jaw and forehead, including inside the mouth. However,
it usually is limited to one side of the face.
In some cases, the cause of trigeminal neuralgia is unknown. In many
people, however, the disorder seems to be related to a local irritation of the trigeminal
nerve, usually in the area of the nerve root deep within the skull. In most cases, the
source of this irritation is believed to be an abnormal blood vessel pressing on the
nerve. Less often, the nerve irritation is related to a tumor that involves the brain or
nerves, or to a rare type of stroke. In addition, up to 8 percent of patients who suffer
from multiple sclerosis (MS) eventually develop trigeminal neuralgia as a result of
MS-related nerve damage.
New cases of trigeminal neuralgia affect four to five out of every 100,000
people in the United States each year. It affects women slightly more often than men,
perhaps because the disease is most common in older people and women live longer. In most
cases, the first episode of facial pain occurs when the patient is 50 to 70 years old.
Although infants, children and young adults may develop this disorder, it is rare in
people younger than age 40.
Symptoms of tTrigeminal Neuralgia
Trigeminal neuralgia causes episodes of sudden, intense facial pain that
usually last for two minutes or less. In most cases, the pain is described as
excruciating, and its quality is "sharp," "stabbing,"
"piercing," "burning," "like lightning" or "like an
electric shock." In most cases, only one side of the face is affected.
The pain of trigeminal neuralgia is recognized as one of the most
excruciating forms of pain known. The pain often is triggered by nonpainful facial
movements or stimuli, such as talking, eating, washing the face, brushing the teeth,
shaving or touching the face lightly. In some cases, even a gentle breeze on the cheek is
enough to trigger an attack. Approximately 50 percent of patients also have specific
trigger points or zones on the face, usually located somewhere between the lips and nose,
where an episode of trigeminal neuralgia can be triggered by a touch or a temperature
change. In some cases, a sensation of tingling or numbness comes before the pain.
Attacks of trigeminal neuralgia can vary significantly, and may occur in
clusters, with several episodes following in series over the course of a day. For unknown
reasons, trigeminal neuralgia almost never occurs at night when the person is sleeping.
In addition to pain, some patients simultaneously have a cheek twitch or
muscle spasm, wincing, a facial flush, a tearing eye or salivation on the same side of the
face. It is the facial muscle spasms that led to the older term, tic douloureux (from
French, tic means muscle twitch or spasm; douloureux means painful).
Diagnosis of Trigeminal Neuralgia
Diagnosis is usually made by eliminating other problems that could cause similar pain
in teeth, jaw, head, or sinuses. Because patients with the condition tend to avoid trigger
points, avoiding chewing, shaving, touching or washing their faces can be a clue to
diagnosis of trigeminal neuralgia.
Treatment of Trigeminal Neuralgia
It is not easy to treat trigeminal neuralgia. Pain can be suppressed by a range of
medicines, including the anti-epilepsy medicines carbamazepine (Tegretol) or phenytoin
(Dilantin). These drugs slow down the nerve signals at certain nerve terminals, which
eases the pain. However, these drugs cause a wide range of side effects, including nausea,
dizziness, drowsiness, liver problems, and skin allergies. Some people develop resistance
to the drugs or they can't tolerate the high dosage needed to control the discomfort. If
the medicines are stopped, the pain usually returns.
If drug treatment fails, surgical treatment to block pain signals from the nerve may be
effective. Radio-frequency waves, gamma rays, or glycerol injections can deaden the nerve
(and hence the pain). An operation that frees the nerve from whatever is compressing it
(blood vessel or tumor) can permanently relieve pain, but this major neurosurgical
procedure carries its own risks and complications. Alternatively, a new procedure seeks to
place a cushioning sponge between the nerve and a pulsating artery wrapping around it to
soothe the irritated nerve.