Trigeminal Neuralgia
(Tic Douloureux)
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The cause is usually an abnormally positioned artery that compresses the trigeminal nerve.
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People have repeated short, lightning-like bursts of excruciating stabbing pain in the lower part of the face.
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Doctors base the diagnosis on the characteristic pain.
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Certain antiseizure drugs, certain antidepressants, or baclofen, may relieve the pain, but surgery is sometimes needed.
(See also Overview of the Cranial Nerves.)
Trigeminal neuralgia usually occurs in middle-aged and older people, although it can affect adults of all ages. It is more common among women.
A common cause of trigeminal neuralgia is
Occasionally in younger people, trigeminal neuralgia results from nerve damage due to multiple sclerosis. Rarely, trigeminal neuralgia results from damage due to compression by a tumor, an abnormal connection between arteries and veins (arteriovenous malformation), or a bulge (aneurysm) in an artery supplying a nerve near the brain.
Symptoms
Pain due to trigeminal neuralgia can occur spontaneously but is often triggered by touching a particular spot (called a trigger point) on the face, lips, or tongue or by an action such as brushing the teeth or chewing. Repeated short, lightning-like bursts of excruciating stabbing pain can be felt in any part of the lower portion of the face but are most often felt in the cheek next to the nose or in the jaw.
Usually, only one side of the face is affected. The pain usually lasts seconds but may last up to 2 minutes. Recurring as often as 100 times a day, the pain can be incapacitating. Because the pain is intense, people tend to wince, and thus the disorder is sometimes called a tic. The disorder commonly resolves on its own, but bouts of the disorder often recur after a long pain-free interval.
Diagnosis
Although no specific test exists for identifying trigeminal neuralgia, its characteristic pain usually makes it easy for doctors to diagnose. However, doctors must distinguish trigeminal neuralgia from other possible causes of facial pain, such as disorders of the jaw, teeth, or sinuses and trigeminal neuropathy (which can cause pain or tingling in the face and impair taste).
Treatment
Because the bouts of pain are brief and recurrent, typical analgesics are not usually helpful, but other drugs, especially certain antiseizure drugs (which stabilize nerve membranes), may help. The antiseizure drug carbamazepine is usually tried first. Oxcarbazepine, gabapentin, or phenytoin, which are also antiseizure drugs, may be prescribed if carbamazepine is ineffective or has intolerable side effects.
Baclofen (a drug used to reduce muscle spasms) or amitriptyline (an tricyclic antidepressant) may be used instead. If amitriptyline has intolerable side effects, another tricyclic antidepressant may be tried.
If the pain continues to be severe, surgery may be done. If the cause is an abnormally positioned artery, a surgeon separates the artery from the nerve and places a small sponge between them. This procedure (called vascular decompression) usually relieves the pain for many years. If the cause is a tumor, the tumor can be surgically removed.
If people have pain unrelieved by drugs and surgery seems too risky, a test can be done to determine whether other procedures would help. For the test, an anesthetic is injected into the nerve to temporarily block its function. If the injection relieves the pain, disrupting the nerve may relieve the pain, sometimes permanently. Disruptions may involve
However, surgery that relieves pain often results in facial numbness. Also, pain often recurs. As a result, people may require many procedures. Having many procedures may increase the risk of developing severe pain that is difficult to treat.
