Trigeminal neuralgia

What is trigeminal neuralgia?

Trigeminal neuralgia, also known as tic douloureux, is a disorder of the trigeminal nerve — the nerve that supplies sensation to your face and controls some of the muscles involved in chewing. Trigeminal neuralgia causes episodes of intense facial pain, which can occur spontaneously or be brought on by certain triggers, such as brushing your teeth, shaving, eating, touching your face, or even smiling. Fully-developed trigeminal neuralgia is one of the most painful conditions known.

Symptoms

The pain of trigeminal neuralgia has been described as sharp and stabbing, or like an electric shock, and is most often felt in the jaw or cheek. It normally comes on suddenly and can last from several seconds to a couple of minutes. Trigeminal neuralgia usually affects only one side of the face at a time.

Sometimes, people with trigeminal neuralgia have a dull ache in the affected side of their face after the shock-like pain has subsided, but most people have no symptoms between attacks.

The pain of trigeminal neuralgia tends to come and go — you may have several attacks a day for a few days, weeks or months, and then be pain-free for months or years.

Causes

Compression of the root of the trigeminal nerve by an abnormally positioned blood vessel is commonly implicated as a cause of trigeminal neuralgia. The pressure on the nerve causes it to misfire, resulting in pain. Occasionally, the compression is caused by a tumour, and often there is no obvious cause found. Other, rarer causes of trigeminal neuralgia include multiple sclerosis and strokes affecting the lower part of the brain.

Trigeminal neuralgia tends to develop after the age of 50 and affect women more often than men.

Trigeminal neuralgia diagnosis

Your doctor will ask about the pain and perform a physical examination, testing the nerves of your head and neck. You may need to have an MRI scan of your head to check for any underlying cause of trigeminal neuralgia.

Treatment

Medicines

Regular pain medicines are generally not helpful in treating trigeminal neuralgia because the episodes of pain are brief and recurrent. However, anticonvulsant medications — the same medicines that are used to control seizures in people with epilepsy — have been found to be effective in relieving this type of nerve pain. Your doctor will most likely prescribe an anticonvulsant such as carbamazepine for the initial treatment of trigeminal neuralgia.

Carbamazepine has been shown to be effective in relieving pain in people with trigeminal neuralgia. However, in some people, this medicine is not well tolerated because of side effects, or becomes less effective in controlling the pain over time. Other anticonvulsants can also be used, either as initial treatment or if carbamazepine is ineffective.

Another medicine that can be used is baclofen, which is normally used to control muscle spasms. Baclofen may be used in combination with an anticonvulsant.

Other treatments

Surgery is an option if your trigeminal neuralgia is the result of a blood vessel compressing your trigeminal nerve. In this type of surgery, any blood vessels that are compressing the trigeminal nerve are removed or relocated. Surgery is more commonly performed in younger people who are in good overall health.

There are also surgical procedures available that are aimed at destroying or damaging the affected part of the trigeminal nerve to reduce or eliminate the pain. These include electrical current treatment, injections into the nerve, balloon compression and gamma-knife radiosurgery. There is a risk of permanent or temporary numbness of the face with these treatments.

Outlook

In most people, trigeminal neuralgia improves with treatment or goes into remission on its own. However, recurrences do occur, often after a long pain-free period. Also, as with any ongoing painful condition, depression may occur, but there are treatments for depression that can help.

Support groups can provide information, reassurance and support to people living with trigeminal neuralgia.

Last Reviewed: 10 April 2013
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References

1. Facial pain (revised June 2011). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2013 Mar. http://online.tg.org.au/complete/ (accessed Apr 2013).
2. Zakrzewska J, Linskey M. Trigeminal neuralgia. Clinical Evidence [online] 2009 [cited Mar 12]. URL: http://clinicalevidence.bmj.com/ (accessed Apr 2013).
3. MayoClinic.com. Trigeminal neuralgia (updated 10 Aug 2012). http://www.mayoclinic.com/health/trigeminal-neuralgia/DS00446 (accessed Apr 2013).
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