Also known as: Tic Douloureux
Trigeminal neuralgia (TN) is an extremely severe facial pain that tends to come and go unpredictably in sudden shock-like attacks. The pain is often described as stabbing, shooting, excruciating, burning, extremely strong. The pain usually lasts for a few seconds, but there can be many bursts of pain in quick succession. It is a chronic disorder of the trigeminal nerve (or fifth cranial nerve) and affects about 8 people in 100,000.
The trigeminal nerve has three branches (or divisions):
- the upper branch (ophthalmic) which runs above the eye, forehead and front of the head the middle branch (maxillary) which runs through the cheek, upper jaw, teeth and gums, side of the nose
- the lower branch (mandibular) which runs through the lower jaw, teeth and gums
TN can involve one or more branches. Most frequently, the middle and lower branches are affected. It usually affects people over 50 years old, but many cases have been reported in young adults, and very rarely among children.
It affects women more than men, and it is more often on the right side of the face. It is not hereditary.
Medical text written November 2007 by Professor Joanna M Zakrzewska, Consultant/Honorary Professor, Facial Pain Lead, Eastman Dental Hospital, UCL Hospitals NHS Foundation Trust, London, UK.
Symtpoms of TN include:
- spasms of sharp, stabbing pain, often described as like a jolt of lightning.
- the pain is confined in the area served by the branches of the TN nerve: lower jaw, upper jaw, cheek, eye and forehead. The pain may include one, two or all three branches of the TN nerve
- pain is almost always on one side of the face, most commonly the right-hand side
- the pain is usually provoked by a light touch on the face, movements of the face (and therefore mouth), washing the face, a light breeze. Trigger points are usually around the nose and lip
- the pain might disappear by itself for weeks, even months, and return.
The cause of TN is still an area for debate among medical professionals. Most believe that the deterioration of the myelin (protective coating of the nerve) allows the transmission of abnormal messages of pain. The damage of the myelin sheath may be caused by pressure from blood vessels or arteries, tumours, multiple sclerosis, injury to the nerve, consequences of shingles, or just the ageing process.
Diagnosis of idiopathic TN is made entirely on history but tests for tumours pressing on the nerve or multiple sclerosis may be required to be eliminate symptomatic TN. Magnetic resonance imaging (MRI) of the brain is done to determine if a blood vessel is pressing on the nerve.
If, after several visits to a dentist, a GP or an oral surgeon, TN is suspected, the patient is sent to a neurologist. He will perform some neurological tests to rule out or discover other diseases. He will also ask for a precise description of the pain. Most doctors will recommend a MRI scan in order to see if there is any obvious cause.
A number of drugs, mainly anti-epileptic, are used to treat TN singly or in combination. As these drugs have a number of side effects, such as drowsiness or a feeling of inability to concentrate, the specific drugs for an individual are dictated by efficacy and affect. If a drug regime fails to alleviate pain or leads to unacceptable side effects, surgery may be considered. There are a wide variety of surgical procedures available, all with their own risks but they give much longer pain relief periods. Due to the rarity of the condition and its severity, sufferers can feel isolated and fearful. Contact with a TN support group may be very helpful.
Trigeminal Neuralgia Association UK
The Association is a Registered Charity in England and Wales No. 1155001. It provides information and support to people affected by Trigeminal Neuralgia, and raises awareness of the condition within the medical community and the general public.
Group details last updated December 2014.