A community of patients, family members and friends dedicated to dealing with Trigeminal Neuralgia, together.
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|Written by LITLEFAWN3|
|21 January 2009|
Trigeminal neuralgia (tic douloureaux) is a disorder of a nerve at the side of the head, called the trigeminal nerve. This condition causes intense, stabbing or electric shock-like pain in the lips, eyes, nose, scalp, forehead and jaw. Although trigeminal neuralgia is not fatal, it is extremely painful.
The main symptom of trigeminal neuralgia is a sudden attack of pain (often described as intense, shooting, stabbing or electrical shock-like) that lasts anywhere from seconds to two minutes. Sometimes the pain hits without warning, while other times even mild stimulation of the face from ordinary activities (such as smiling, brushing teeth, eating, drinking, applying makeup, combing or brushing hair, shaving or touching the skin) can trigger a pain attack. At first the attacks may be short and relatively mild, but over time they last longer, are more painful and happen more often.
The trigeminal nerve has three branches in the face, each of which controls a different part of the face, and any or all branches of the nerve may be affected. The pain typically involves only one side of the face. It can affect the upper, middle or lower portions of the face or all of them. The pain never crosses over to the other side of the face. In rare cases, trigeminal neuralgia is felt on both sides of the face, but the right side pain is separate and distinct from the left side pain.
When experiencing an attack of trigeminal neuralgia, individuals will almost always want to be still and avoid talking or moving the face. The pain may cause the face to contort into a painful wince. Attacks of trigeminal neuralgia rarely occur while sleeping.
During certain periods, the attacks of pain may be worse or more frequent. Individuals may also have extended times with no pain (remission). One of the challenges of trigeminal neuralgia is the inability to predict when the next flare-up may happen. Especially severe flare-ups may produce so many pain attacks that the pain feels nearly constant. In severe or long-term cases of trigeminal neuralgia, an aching pain or light numbness may develop in the affected area of the face.
Causes and Risk Factors
The pain of trigeminal neuralgia is usually caused by pressure on the trigeminal nerve at the base of the brain. The pressure can be result from:
Trigeminal neuralgia is not easy to diagnose. Neurologic tests and physical examination of the skull and face usually reveal no abnormality. A person experiencing unexplained facial pain may be mistakenly diagnosed as having a dental condition, disorders of the hinge of the jaw (temporomandibular joint), sinus infections, eye conditions, migraines, temporal arteritis or even psychologic disorders. Any doctor or dentist who sees patients with facial, gum or jaw pain should be alert to the possibility that the condition is trigeminal neuralgia.
Usually a diagnosis is based on the description of the pain and related features. The doctor must also eliminate the possibility of other conditions that also may cause facial pain. If the pain is relieved by treatment for trigeminal neuralgia, the diagnosis of the condition is usually confirmed. No known clinical or laboratory tests or X-rays can confirm trigeminal neuralgia. It may be necessary to order an MRI which, in some cases, can help identify the vessel pressing on the nerve.
The first treatment for trigeminal neuralgia is usually drug therapy. Certain medications can help lessen or block pain. Additionally, drugs that are designed to control convulsions or seizures or some anti-depressant drugs can be helpful in relieving pain. Drugs that may be prescribed include:
Resources at Cedars-Sinai
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