Trigeminal Neuralgia (TN), also called tic douloureux, is a condition that affects the trigeminal nerve (the 5th cranial nerve), one of the largest nerves in the head. The trigeminal nerve is responsible for sending impulses of touch, pain, pressure, and temperature to the brain from the face, jaw, gums, forehead, and around the eyes. TN is characterized by a sudden, severe, electric shock-like or stabbing pain typically felt on one side of the jaw or cheek. In some patients, the eye, the ear or the palate may be affected. In many patients, the attacks are less frequent at night or when the patient lies down. The disorder is more common in women than in men and rarely affects anyone younger than 50. In reality, TN is known to exist in many younger individuals including children.
The attacks of pain, which generally last several seconds and may be repeated one after the other, may be triggered by talking, brushing teeth, touching the face, shaving, applying makeup, chewing, or swallowing. The attacks may come and go throughout the day and last for days, weeks, or months at a time, and then disappear for months or years.
In the initial stages, before the symptoms develop completely, TN is often confused with other diseases or dental problems. Some patients experience "atypical" trigeminal neuralgia, with more constant pain at a level generally of lower intensity. The rarity of these disturbances and the variability of these symptoms have caused some patients to undergo endodontic treatment of multiple root canals or other oral or sinus surgeries before a neurological disturbance is recognized. Several syndromes are closely related to TN, but have specific unique features as well. These include post-herpetic neuralgia, atypical facial pain (ATFP), and TN resulting from multiple sclerosis (MS). Glossopharyngeal neuralgia is another neurological disturbance potentially related which causes throat pain and difficulty in swallowing. Some patients complain of sensation of burning or of having a fish-bone in the throat.
The diagnosis of trigeminal neuralgia may be made by obtaining a history of paroxysmal one-sided facial pain activated by several facial stimuli. A slight stimulation of the trigger point provokes pain. The relief of pain by carbamazepine gives more credit to the diagnosis of trigeminal neuralgia and treatment by a neurosurgeon.
Conventional treatment for TN typically includes anticonvulsant medications such as carbamazepine or phenytoin. Baclofen, clonazepam, gabapentin, and valproic acid may also be effective and may be used in combination to achieve pain relief. If medication fails to relieve pain, surgical treatment may be recommended.
The disorder is characterized by recurrences and remissions, and successive recurrences may incapacitate the patient. Due to the intensity of the pain, even the fear of an impending attack may prevent activity. Trigeminal neuralgia is not fatal.
Other conditions that may mimic TN include odontogenic pain, glossopharyngeal neuralgia, temporomandibular disorders, cluster headache, hemicrania, and SUNCT (short-lasting, unilateral neuralgia from headache attacks with conjunctival injection and tearing) syndrome.