About Trigeminal Neuralgia
Trigeminal neuralgia (TN), formerly called tic douloreux, is the most common facial pain syndrome and is often described as "the most terrible pain known to man". It is characterized by sudden (paroxysmal) attacks of facial pain described as intense, sharp, electric-shock like, or stabbing. The pain is most commonly felt in the cheekbone, nose, upper lip and upper teeth. In some people, the pain also extends to the lower lip, teeth, and chin. Pain is usually felt on one side of the face (unilateral) and lasts from a few seconds to two minutes. People with TN report that the intermittent pain attacks and the anticipatory anxiety of not knowing when they will occur result in a significant deterioration of quality of life and interfere with daily activities such as eating and sleeping. Typically, TN is caused by compression of the trigeminal nerve by a blood vessel near the brainstem. In many cases, however, a specific cause cannot be identified. This is referred to as idiopathic trigeminal neuralgia.
The International Association for the Study of Pain (IASP) classifies TN into the following 3 types based on the underlying causes of the condition:
Idiopathic TN - no apparent cause can be identified.
Classic TN - caused by a blood vessel compressing the trigeminal nerve root.
Secondary TN - most frequently caused by multiple sclerosis or a benign tumor at the cerebellopontine angle, which is an area located between the cerebellum and the pons (a part of the brainstem).
Various studies have estimated the incidence of TN to range from 4 to 27 cases per 100,000 per year. The condition affects women more often than men. In one large study published in 2016, the proportion of women to men with TN was about 3 to 1.TN is most commonly observed in people between the ages of 37 to 67 years. The average age of onset of classic TN is 53, while patients with secondary TN tend to be about 10 years younger with an average age of onset of 43 years.
Many patients describe a specific triggering event that may precipitate an attack of classic TN. These triggers can include chewing, talking, swallowing, tooth brushing, and shaving.
The diagnosis of trigeminal neuralgia is a clinical one based on the history of an individual's signs and symptoms. Once the diagnosis has been established clinically, magnetic resonance imaging (MRI) is often used to determine if the pain is caused by compression of the trigeminal nerve root by a blood vessel.
The hallmark feature of trigeminal neuralgia is orofacial pain which the IASP defines as "sudden, unilateral, severe, brief, stabbing, recurring episodes of pain in the distribution of one or more branches of the trigeminal nerve".
Orofacial pain may occur as a result of several other medical conditions. These conditions must be excluded before a doctor reaches a definitive diagnosis of trigeminal neuralgia. Other possible causes of facial pain that must be taken into consideration include ear infections, sinusitis, acute glaucoma, "phantom" tooth pain, and post-herpetic neuralgia.
The two primary goals of treatment for trigeminal neuralgia are:
- Controlling the symptoms
- Treating an identified underlying cause of TN
In general, the following treatment options are available for patients with trigeminal neuralgia:
- Drug therapy
- Surgical therapy
- Sterotactic Radiosurgery
- Percutaneous procedures
- Nerve blocks
Trigeminal neuralgia is not a life-threatening illness. Some patients experience a remission of pain lasting many years, while for others the symptoms intensify. Patients should monitor symptoms and discuss them with a physician so that appropriate steps to manage pain can be taken.
Many patients with trigeminal neuralgia experience recurrences of intense painful episodes. Initially most patients will respond to drug therapy, but over time medications become less effective and patients may begin to experience more frequent painful attacks as well as shorter periods of pain relief between episodes. When the pain becomes intractable or interferes significantly with daily activities, patients should be offered other available treatment options.
The Medifocus Guidebook on Trigeminal Neuralgia is a unique, comprehensive patient education resource that contains vital information about Trigeminal Neuralgia that you won't find anywhere else in a single resource. The Guidebook will answer many of your questions about this condition that your healthcare provider may not have the time to answer. To learn more about the Guidebook, please click here
