Trigeminal Neuralgia

(Tic Doleureux)

Definition

Trigeminal neuralgia (TN) is a problem with the trigeminal nerve. The nerve senses touch, pain, pressure, and temperature. It also helps make saliva and tears. TN causes severe, shooting pain along one side of the face.

The Trigeminal Nerve

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Causes    TOP

In most cases, the cause is unknown. In some, it may be caused by an abnormally formed artery or vein near the nerve. The blood vessel can press on the nerve and cause problems.

Rarely, TN may happen as a symptom of another health problem, such as:

Risk Factors    TOP

TN is more common in women. It is also more common in people aged 50 years or older. Having multiple sclerosis may raise your risk.

Symptoms    TOP

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, it may happen in the eye or forehead. Twitching or wincing may also happen.

The pain is sudden, severe, and stabbing. Even though the pain lasts less than 2 minutes, it can reoccur hundreds of times a day. Attacks can become totally disabling. They may seem to happen without notice or be triggered by temperature, washing, shaving, touching, or tickling the face. There may not be symptoms between attacks, except perhaps a dull ache.

Pain may come and go for days, weeks, months, or years. It may stop for months or years between attacks. Over time, the attacks may become more frequent and more severe.

Diagnosis    TOP

Your doctor will ask about your symptoms and health history. A physical exam will be done.

You may have an electrophysiologic test called a trigeminal reflex test.

Other tests, such as an MRI scan can take pictures of the head and the structures around it.

Treatment    TOP

Talk with your doctor about the best plan for you. Here are some options:

Medications

Your doctor may advise:

  • Antiseizure medicine
  • Muscle relaxants
  • Antidepressants
  • Nasal sprays
  • Injections

Surgery

Surgery may be an option if other methods fail. Microvascular decompression removes an artery or tumor that is pressing on the nerve. Other surgeries may be used to cut the trigeminal nerve.

Prevention    TOP

TN can’t be prevented.

RESOURCES:

American Chronic Pain Association
http://www.theacpa.org
Facial Pain Association
http://fpa-support.org

CANADIAN RESOURCES:

Trigeminal Neuralgia Association of Canada
http://tnac.org/tnac

References:

Chole R, Pati R, Degwekar SS, Bhowate RR. Drug treatment of trigeminal neuralgia: a systematic review of the literature. J Oral Maxillfac Surg. 2007;65(1):40-45.
Gorgulho A, DeSalles A. Trigeminal neuralgia: impact of radiosurgery on the surgical treatment of trigeminal neuralgia. Surg Neurol. 2006;66(4):350-356.
Kalkanis SN, Eskandar EN, Carter BS, Barker FG 2nd. Microvascular decompression surgery in the United States, 1996-2000: mortality rates, morbidity rates, and the effects of hospital and surgeon volumes. Neurosurgery. 2003;52(6):1251-1261.
NINDS trigeminal neuralgia information page. National Institute of Neurological Disorders and Stroke website. Available at: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Trigeminal-Neuralgia-Fact-Sheet. Updated May 10, 2017. Accessed June 25, 2018.
Pollock BE, Ecker RD. A prospective cost-effectiveness study of trigeminal neuralgia surgery. Clin J Pain. 2005;21(4):317-322.
Trigeminal neuralgia. American Academy of Neurological Surgeons website. Available at:
...(Click grey area to select URL)
Accessed June 25, 2018.
Trigeminal neuralgia. EBSCO DynaMed Plus website. Available at: http://www.dynamed... . Updated March 20, 2018. Accessed June 25, 2018.
Viel M. Pregabalin for the treatment of trigeminal neuralgia. Am Fam Physician. 2008;78(7):808.
11/29/2006 DynaMed Plus Systematic Literature Surveillance http://www.dynamed... : Kanai A, Saito M, Hoka S. Subcutaneous sumatriptan for refractory trigeminal neuralgia. Headache. 2006;46(4):577-582.
Last reviewed May 2018 by EBSCO Medical Review Board Rimas Lukas, MD
Last Updated: 6/25/2018

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