Trigeminal Neuralgia

What is Trigeminal Neuralgia

Trigeminal neuralgia is a nerve disorder that causes attacks of severe facial pain.

The attacks last from a few seconds to several minutes.

They can happen for days, weeks, or months and then go away for months or years. Trigeminal neuralgia is also called tic douloureux.

How common is trigeminal neuralgia? 

The estimated prevalence is 1 per 20,000 people suffer from this disorder.

What are the causes?

This condition is caused by damage to a nerve in the face that is called the trigeminal nerve. An attack can be triggered by:

  • Talking.
  • Chewing.
  • Putting on makeup.
  • Washing your face.
  • Shaving your face.
  • Brushing your teeth.
  • Touching your face.

The most common cause is a tortuous vessel compressing the trigeminal ganglia.

Other causes include aneurysm, tumor, and multiple sclerosis.

It may also be idiopathic.

What increases the risk?

This condition is more likely to develop in:

  • Women.
  • People who are 50 years of age or older.

What are the symptoms of Trigeminal Neuralgia?

The main symptom of this condition is pain in the jaw, lips, eyes, nose, scalp, forehead, and face. The pain may be intense, stabbing, electric, or shock-like.

Typical manifestation is a paroxysmal pain that is described as either lancinating, boring, hot poker-like, or intense electrical “zap” in the trigeminal neural distribution.

Which division of the trigeminal nerve is most commonly affected? 

The maxillary division (V2) is affected most, then mandibular (V3), followed by the ophthalmic division (V1) in about 5% of cases. Bilateral involvement occurs in 10% of individuals. Involvement of all three divisions rarely occurs.

How is this diagnosed?

This condition is diagnosed with a physical exam. A CT scan or MRI may be done to rule out other conditions that can cause facial pain.

Magnetic resonance imaging (MRI) and magnetic resonance angiogram of the brain are suggested in order to exclude tumors, aneurysms, arachnoid cysts, multiple sclerosis plaque, or anomalous vasculature.

How is Trigeminal Neuralgia treated?

This condition may be treated with:

  • Avoiding the things that trigger your attacks.
  • Pain medicine.
  • Surgery. This may be done in severe cases if other medical treatment does not provide relief.

Anticonvulsant therapy is a mainstay.

The drug of first choice is carbamazepine or its congener, oxcarbazepine. Other alternatives include phenytoin, valproate, baclofen, and lamotrigine.

Lacosamide is a relatively new and promising addition to the armamentarium. If pharmacotherapy fails, then microvascular decompression (Janetta procedure) is the preferred step.

Balloon compression, rhizotomy, and gamma knife therapy are other options.

Follow these instructions at home:

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • If you wish to get pregnant, talk with your health care provider before you start trying to get pregnant.
  • Avoid the things that trigger your attacks. It may help to:
    • Chew on the unaffected side of your mouth.
    • Avoid touching your face.
    • Avoid blasts of hot or cold air.

Contact a health care provider if:

  • Your pain medicine is not helping.
  • You develop new, unexplained symptoms, such as:
    • Double vision.
    • Facial weakness.
    • Changes in hearing or balance.
  • You become pregnant.

Get help right away if:

  • Your pain is unbearable, and your pain medicine does not help.

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