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Trigeminal Neuralgia

(Tic Doleureux)
  • Definition

    Trigeminal neuralgia (TN) is a disorder of the trigeminal nerve (fifth cranial nerve) that causes severe, shooting pain along one side of the face. The trigeminal nerve senses touch, pain, pressure, and temperature. It also helps make saliva and tears.
    The Trigeminal Nerve
    Nuclus factsheet image
    Copyright © Nucleus Medical Media, Inc.
    In TN, pain usually lasts for less than a second to a few seconds and may come and go for days, weeks, months, or years. It may go into remission or stop completely for months or years. Over time, though, the attacks may become more frequent and more severe.
  • Causes

    In most cases, the cause is unknown. In some cases, it may be caused by an abnormally formed artery or vein near the nerve. The blood vessel can compress the nerve and cause problems. Rarely, TN may occur as a symptom of another underlying disorder, such as:
  • Risk Factors

    TN is more common in women aged 50 years or older. Having certain medical conditions, such as multiple sclerosis , or high blood pressure may increase your risk of TN.
  • Symptoms

    The main symptom is searing pain on one side of the face. The pain may be felt inside the mouth or in the lips, cheek, chin, nostril, ear, or near the eye. Rarely, pain may occur in the eye or forehead. Twitching or wincing sometimes accompanies the pain.
    The pain is typically sudden, severe, and stabbing. Even though the pain is brief, usually less than two minutes, it can reoccur hundreds of times a day. Attacks can become totally disabling. They may seem to occur at random or be triggered by extremes of temperature, washing, shaving, touching, or tickling the face. There are usually no symptoms between attacks, except perhaps a dull ache.
  • Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will be done. You may have an electrophysiologic test called a trigeminal reflex test. Other tests, such as a CT scan or MRI scan can take evaluate the head and surrounding structures.
    You may be given antiseizure medication to help diagnose the disorder.
  • Treatment

    Talk with your doctor about the best treatment plan for you. Options include:
    Medications
    Your doctor may recommend:
    • Antiseizure medications
    • Antidepressants
    • Muscle relaxers
    • Nasal sprays
    • Injections
    Surgery
    Surgery may be an option if medications fail to relieve symptoms. Microvascular decompression removes an artery or tumor that is pressing on the nerve. Other procedures may be used to cut the trigeminal nerve.
  • Prevention

    There are no current guidelines to prevent TN.
  • RESOURCES

    American Chronic Pain Association http://www.theacpa.org

    The Facial Pain Association http://www.fpa-support.org

    CANADIAN RESOURCES

    Health Canada http://www.hc-sc.gc.ca

    The Canadian Trigeminal Neuralgia Association http://www.catna.ca

    References

    Chole R, Pati R, et al. Drug treatment of trigeminal neuralgia: a systematic review of the literature. J Oral Maxillfac Surg. 2007; 65:40-45.

    Gorgulho A, DeSalles A. Trigeminal neuralgia: impact of radiosurgery on the surgical treatment of trigeminal neuralgia. Surgical Neurology. 2006;66:350-356.

    Kalkanis SN, Eskandar EN, et al. Microvascular decompression surgery in the United States, 1996-2000: mortality rates, morbidity rates, and the effects of hospital and surgeon volumes. Neurosurgery. 2003;52:1251-1261.

    NINDS trigeminal neuralgia information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/trigeminal%5Fneuralgia/trigeminal%5Fneuralgia.htm. Updated November 30, 2012. Accessed June 28, 2013.

    Pollock BE, Ecker RD. A prospective cost-effectiveness study of trigeminal neuralgia surgery. Clin J Pain. 2005;21:317-22.

    Trigeminal neuralgia. American Academy of Neurological Surgeons website. Available at: http://www.aans.org/Patient%20Information/Conditions%20and%20Treatments/Trigeminal%20Neuralgia.aspx. Updated August 2012. Accessed June 28, 2013.

    Trigeminal neuralgia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 29, 2012. Accessed June 28, 2013.

    Viel M. Pregabalin for the treatment of trigeminal neuralgia. Am Fam Physician. 2008;78:808.

    11/29/2006 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Kanai A, Saito M, et al. Subcutaneous sumatriptan for refractory trigeminal neuralgia. Headache. 2006;46:577-582.

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