What Is Trigeminal Neuralgia?
Trigeminal neuralgia, also known as tic douloureux, is a disorder in which trigeminal nerves are damaged, causing extreme pain in affected individuals.
What Are Trigeminal Nerves?
There are two distinct trigeminal nerves on each side of the face. Each nerve has three branches in separate facial areas (chin, midface and forehead). When injured, trigeminal nerves can no longer process pain signals or other sensations from the face to the brain properly.
There are multiple reasons why you could be suffering from this condition. Trigeminal neuralgia can be caused by a swollen blood vessel pressing on a trigeminal nerve as it exits the brain stem. This compression damages the protective coating around the nerve known as the myelin sheath. Since multiple sclerosis can also injure the myelin sheath, some individuals are diagnosed with both multiple sclerosis and trigeminal neuralgia.
Rarer causes include:
- Nerve compression from a tumor
- Nerve compression due to an arteriovenous malformation (a tangle of arteries)
- Sinus or oral surgery injuring one of the trigeminal nerves
- Facial trauma causing trigeminal nerve damage
Some cases have no apparent cause, making diagnosis and treatment a difficult task.
Trigeminal neuralgia pain is often described as severe, brief and sharp pain that can be felt in the cheek, jaw, teeth, gums, lip, eye and forehead. The pain becomes dull in between jolts that resemble electric shocks. Symptoms usually occur on one side of the face and rarely affect both sides.
Trigeminal neuralgia symptoms can be triggered by routine activities, such as:
- Brushing teeth
- Applying makeup
- Eating or drinking
- Feeling a light touch, cold air or gusts of wind on the face
You may experience bursts of pain that last only seconds or minutes. Pain may first be mild and short but worsen over time. Symptoms usually occur in cycles, in which individuals will experience pain on and off for days or weeks. Other patients report that pain is always present. Some individuals diagnosed with trigeminal neuralgia can experience up to 100 attacks a day.
If you suspect that your trigeminal nerve is injured, you’ll need to visit a headache specialist who can evaluate your symptoms and diagnose your condition correctly. Your physician will perform a thorough physical exam and evaluate your medical history. He or she will perform a neurological exam that will help determine which area of the trigeminal nerve is damaged.
Before a diagnosis can be made, your medical team will need to rule out conditions with comparable symptoms, such as postherpetic neuralgia and cluster headaches. An MRI of your brain and spine will rule out brain tumors and multiple sclerosis, as well as determine if a blood vessel is pressing against a branch of the trigeminal nerve.
Trigeminal Neuralgia Treatment
Although the condition is not life-threatening, patients report that pain can be particularly severe and debilitating.
Milder cases usually respond well to medication; however, prescription or over-the-counter pain drugs are typically ineffective. Pharmacological therapy for trigeminal neuralgia focuses on anticonvulsants (such as carbamazepine or gabapentin) to block nerve firing, muscle relaxants, opiates and tricyclic antidepressants. Additionally, trigeminal nerve blocks, trigger point injections and neurological scalp acupuncture can effectively help minimize your facial pain.
You might also be a candidate for surgery. Trigeminal neuralgia surgery involves ablating the damaged portion of the nerve to prevent the occurrence of pain signals to the brain. On the other hand, brain surgery for trigeminal neuralgia involves the neurosurgical repair of any small aneurysm that is putting pressure on your trigeminal nerve.
Trigeminal neuralgia is a difficult condition with which to live and can often lead to depression. You may benefit from psychological intervention, massage therapy and biofeedback to relieve any anxiety and stress that you may experience.