Trigeminal Neuralgia (TN) is a pain that is described as among the most acute known to mankind. TN produces excruciating, lightning strikes of facial pain, typically near the nose, lips, eyes or ears.
TN is a disorder of the fifth cranial (trigeminal) nerve that causes episodes of intense, stabbing, electric shock-like pain in the areas of the face where the branches of the nerve are distributed – lips, eyes, nose, scalp, forehead, upper jaw, and lower jaw. By many, it’s called the ‘suicide disease’. A less common form of the disorder called ‘Atypical Trigeminal Neuralgia’ may cause less intense, constant, dull burning or aching pain, sometimes with occasional electric shock-like stabs. Both forms of the disorder most often affect one side of the face, but some patients experience pain at different times on both sides.
Onset of symptoms occurs most often after age 50, but cases are known in children and even infants. Something as simple and routine as brushing the teeth, putting on makeup or even a slight breeze can trigger an attack, resulting in sheer agony for the individual. TN is not fatal, but it is universally considered to be the most painful affliction known to medical practice.
Initial treatment of TN is usually by means of anti-convulsant drugs, such as Tegretol or Neurontin. Some anti-depressant drugs also have significant pain relieving effects. Should medication be ineffective or if it produces undesirable side effects, neurosurgical procedures are available to relieve pressure on the nerve or to reduce nerve sensitivity. Some patients report having reduced or relieved pain by means of alternative medical therapies such as acupuncture, chiropractic adjustment, self-hypnosis or meditation.
Signs and Symptoms
An attack of TN can last from a few seconds to about a minute. Some people have mild, occasional twinges of pain, while other people have frequent, severe, electric-shock-like pain. The condition tends to come and go. You may experience attacks of pain off and on all day, or even for days or weeks at a time. Then, you may experience no pain for a prolonged period of time. Remission is less common the longer you have trigeminal neuralgia.
People who have experienced severe trigeminal neuralgia have described the pain as:
|Lightning-like or electric-shock-like|
|Like having live wires in your face|
TN usually affects just one side of your face. The pain may affect just a portion of one side of your face or spread in a wider pattern. Rarely, it can affect both sides of your face, but not at the same time.
The condition is called trigeminal neuralgia because the painful facial areas are those served by one or more of the three branches of your trigeminal nerve. This large nerve originates deep inside your brain and carries sensation from your face to your brain. The pain of trigeminal neuralgia is due to a disturbance in the function of the trigeminal nerve. Trigeminal neuralgia is also known as tic douloureux.
The cause of the pain usually is due to contact between a normal artery or vein and the trigeminal nerve at the base of your brain. This places pressure on the nerve as it enters your brain and causes the nerve to misfire. Physical nerve damage or stress may be the initial trigger for trigeminal neuralgia.
After the trigeminal nerve leaves your brain and travels through your skull, it divides into three smaller branches, controlling sensation throughout your face:
|The first branch controls sensation in your eye, upper eyelid and forehead|
|The second branch controls sensation in your lower eyelid, cheek, nostril, upper lip and upper gum|
|The third branch controls sensations in your jaw, lower lip, lower gum and some of the muscles you use for chewing|
You may feel pain in the area served by just one branch of the trigeminal nerve, or the pain may affect all branches on one side of your face. Besides compression from blood vessel contact, other less frequent sources of pain to the trigeminal nerve may include:
|Compression by a tumor|
|A stroke affecting the lower part of your brain, where the trigeminal nerve enters your central nervous system|
A variety of triggers, many subtle, may set off the pain. These triggers may include:
|Stroking your face|
|Brushing your teeth|
|Putting on makeup|
|Encountering a breeze|
Trigeminal neuralgia affects women more often than men. The disorder is more likely to occur in people who are older than 50. About 5 percent of people with trigeminal neuralgia have other family members with the disorder, which suggests a possible genetic cause in some cases.