What Is Trigeminal Neuralgia?

Causes and Treatment Options

Woman with toothache or headache, holding her hand to her temple
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Imagine the worst pain you've ever felt striking you in the face in severe and sudden attacks and you can begin to understand trigeminal neuralgia. Here's what you should know about the painful condition, including causes, symptoms, diagnosis and treatment options.

What Is Trigeminal Neuralgia?

Trigeminal neuralgia, sometimes called tic douloureux, is a neuropathic pain disorder that causes severe facial pain, often in one cheek.

It is characterized by pain attacks that come in short bursts and last anywhere from seconds to minutes. These attacks may continue for weeks or even months at a time.

Trigeminal neuralgia is a relapsing-remitting pain condition. That is, between episodes, the person is generally pain-free. In fact, for some people, many years may go by between episodes.

Causes of Trigeminal Neuralgia

The exact cause of the condition is a bit of a mystery. It may be caused by irritation of the trigeminal nerve, sometimes by a blood vessel or swelling in the brain. However, some cases of trigeminal neuralgia are associated with disorders that affect structures in the brain, such as multiple sclerosis.

Once a person has trigeminal neuralgia, pain episodes may be triggered by contact with the cheek or jaw, or by vibration (such as an electric toothbrush). However, a person may experience preliminary facial discomfort or tingling a few days before an attack.

Diagnosing Trigeminal Neuralgia

Diagnosing trigeminal neuralgia can be a long process, as no single test can identify it. In fact, some testing for the condition is designed to rule out other disorders, such as postherpetic neuralgia or cluster headaches. If your doctor thinks you have trigeminal neuralgia, he or she will want to get a detailed medical history and perform a physical and a detailed neurological test.

 Your doctor may also recommend an MRI scan and will want to rule out trigeminal nerve damage caused by injury, such as a facial fracture or a stroke.

Treatment Options for Trigeminal Nueralgia

Trigeminal neuralgia may be treated with any of the following:

  • Anticonvulsants, such as gabapentin or carbamazepine
  • Tricyclic antidepressants, such as amitriptyline or nortriptyline
  • Microvascular decompression, in which surrounding blood vessels are separated from the trigeminal nerve
  • Rhizotomy, in which a portion of the trigeminal nerve is destroyed
  • Complementary treatments, such as acupuncture or electrical stimulation

Looking Ahead: The Prognosis

Trigeminal neuralgia is difficult to treat. Because it comes and goes, a person may be pain free for months or years between attacks. However, for some people, attacks grow worse over time. Trigeminal neuralgia is not life-threatening, but it can be incredibly painful and can interfere with person's quality of life.

Evidence for treatment is variable. Some people can manage their pain with medications, while others opt for surgery.

However, surgery has its own risks, and it may still cause a relapse in some individuals. Research into effective treatments for trigeminal neuralgia is ongoing.

Sources:

Medline Plus. Trigeminal Neuralgia. Accessed 12/6/09. http://www.nlm.nih.gov/medlineplus/ency/article/000742.htm

Merrison, Andria F and Fuller, Geriant. Treatment Options for Trigeminal Neuralgia. British Medical Journal. 2003 December 13; 327(7428): 1360-1361.

National Institute of Neurological Disorders and Stroke. NINDS Trigeminal Neuralgia Information Page. Accessed 12/6/09. http://www.ninds.nih.gov/disorders/trigeminal_neuralgia/trigeminal_neuralgia.htm

National Institute of Neurological Disorders and Stroke. Trigeminal Neuralgia Fact Sheet. Accessed 12/6/09. http://www.ninds.nih.gov/disorders/trigeminal_neuralgia/detail_trigeminal_neuralgia.htm

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