Trigeminal neuralgia, also known as tic douloureux, is a neurological disorder affecting the trigeminal nerve, the nerve that carries sensory information from the face to the brain. This chronic condition causes severe, shooting pain in the face, sometimes as fleeting, momentary twinges, other times as frequent bouts of excruciating pain. Because the trigeminal nerve is responsible for sensation all around the face, including the eyes, mouth and sinus cavities, trigeminal neuralgia can result in pain on one side of the jaw, cheek or mouth, or, less frequently, near the forehead or one of the eyes.
The pain usually comes on suddenly and, although it lasts from a few seconds to a few minutes, may be physically and mentally incapacitating. When the pain occurs along the cheek or jaw, it is sometimes mistaken for a severe toothache.
Episodes may be triggered by activities that cause a vibration in the cheek, such as shaving, brushing the teeth, applying makeup, eating, drinking or talking, or even encountering a slight breeze. As the condition progresses, the episodes of pain may become longer and more frequent.
Causes of Trigeminal Neuralgia
An exact cause of trigeminal neuralgia has not been established, although in many cases it is brought on by contact between a blood vessel and the trigeminal nerve. It may be the result of an artery or vein compressing the trigeminal nerve as it exits the brain. The condition occurs most often in people age 50 and older and affects more women than men.
It may be the result of aging or related to neurological conditions that damage the myelin sheath, such as multiple sclerosis. More rarely, trigeminal neuralgia may be caused by a tumor on the trigeminal nerve. In some cases, trigeminal neuralgia is idiopathic, meaning it has no discernible cause.
Diagnosis of Trigeminal Neuralgia
Diagnosis of trigeminal neuralgia involves determining the location of the pain, the type of pain experienced, and precisely what triggers the sensation. The diagnosis can be confirmed thorough an evaluation of the patient's medical history and the administration of certain neurological tests. Tests of sensitivity and reflexes in the face enable the doctor to assess which part of the trigeminal nerve is responsible for the problem. An MRI of the head may be administered to determine whether an underlying condition, such as multiple sclerosis or a tumor, is causing the difficulty. Various blood tests may also be necessary. Sometimes a magnetic resonance angiogram, during which contrast dye is injected into a blood vessel to highlight blood flow, may be administered.
Treatment for Trigeminal Neuralgia
Treatment for trigeminal neuralgia may include medications such as anticonvulsants, antidepressants or muscle relaxants. In some cases, the right medication can relieve the pain and also lessen the frequency or severity of episodes. Unfortunately, medications which may successfully curb the symptoms of trigeminal neuralgia, will, for some patients, become less effective over time.
For more severe or unresponsive cases, surgery may be the most promising method of treatment. Several different kinds of surgical procedures can be used to reduce the amount of pressure being placed on the trigeminal nerve. These may involve cutting away a portion of the nerve, obliterating the nerve through injection or radiofrequency ablation, or removing a tumor or blood vessel responsible for the nerve compression.
Some patients are able to manage the symptoms of trigeminal neuralgia by combining drug therapy with alternative treatments such as acupuncture, biofeedback or vitamin therapy.