Summary about Disease
Trigeminal neuralgia (TN), also known as tic douloureux, is a chronic pain condition that affects the trigeminal nerve (fifth cranial nerve), which carries sensation from your face to your brain. Even mild stimulation of your face — such as from brushing your teeth or putting on makeup — may trigger a jolt of excruciating pain. It is characterized by sudden, severe facial pain that typically lasts from a few seconds to several minutes per episode. The pain is often described as shooting, stabbing, burning, or electric shock-like.
Symptoms
Episodes of severe, shooting or jabbing pain that may feel like an electric shock.
Spontaneous attacks of pain or attacks triggered by things like touching the face, chewing, speaking or brushing teeth.
Bouts of pain lasting from a few seconds to several minutes.
Pain occurring in the jaw, teeth, gums, lips, cheek, eye and forehead.
Pain affecting one side of the face at a time.
Pain that becomes more frequent and intense over time.
Numbness/Tingling preceding pain.
Causes
Blood vessel pressing on the trigeminal nerve: In many cases, trigeminal neuralgia is caused by a blood vessel (usually an artery) pressing on the trigeminal nerve as it exits the brainstem. This pressure can damage the protective myelin sheath around the nerve.
Multiple sclerosis (MS) or other neurological disorders: TN can be associated with MS or other conditions that damage the myelin sheath.
Tumor: Rarely, a tumor may press on the trigeminal nerve.
Other Causes: In some cases, the cause is unknown.
Medicine Used
Anticonvulsants: Carbamazepine and oxcarbazepine are commonly used to reduce nerve firing and block pain signals.
Muscle Relaxants: Baclofen is sometimes used in combination with anticonvulsants.
Tricyclic Antidepressants: Amitriptyline or nortriptyline may be used for pain management.
Other medications: Gabapentin, pregabalin, clonazepam, phenytoin.
Is Communicable
No, trigeminal neuralgia is not communicable. It is not caused by an infectious agent and cannot be spread from person to person.
Precautions
Avoid triggers: Identify and avoid activities or stimuli that trigger pain episodes (e.g., cold air, chewing, touching the face).
Maintain good oral hygiene: Gentle oral care is important to prevent dental problems and reduce the risk of triggering pain.
Manage stress: Stress can exacerbate pain; stress-reduction techniques may be helpful.
Follow medical advice: Adhere to prescribed medication regimens and attend follow-up appointments with your doctor.
Protect Face: Protect your face from extreme temperatures or wind.
How long does an outbreak last?
The duration of pain episodes can vary significantly. Some individuals experience short bursts of pain lasting only a few seconds, while others have episodes that persist for several minutes. Periods of remission (when pain is absent) can also vary, lasting for weeks, months, or even years. However, without treatment, the condition tends to worsen over time, with more frequent and severe pain attacks.
How is it diagnosed?
Neurological examination: To assess the trigeminal nerve function and rule out other neurological conditions.
Medical history: The doctor will ask about the characteristics, location, and triggers of the pain.
MRI Scan: To rule out tumors, multiple sclerosis, or other structural abnormalities that could be causing the nerve compression or damage.
Pain Diary: A detailed record of pain episodes, triggers, and relief measures.
Timeline of Symptoms
The onset of trigeminal neuralgia is often sudden.
Initial Stage: Mild, infrequent pain episodes, often misdiagnosed as dental problems.
Progression: Increased frequency and intensity of pain attacks, with identifiable triggers.
Chronic Stage: Pain becomes more constant and debilitating, with shorter periods of remission.
Treatment Impact: With effective treatment, the frequency and severity of pain can be significantly reduced, leading to longer periods of remission.
Important Considerations
Mental Health: Chronic pain can lead to depression, anxiety, and social isolation. Mental health support is crucial.
Medication Side Effects: Be aware of potential side effects of medications and discuss them with your doctor.
Surgical Options: If medications are ineffective, surgical procedures (e.g., microvascular decompression, radiofrequency ablation) may be considered.
Alternative Therapies: Some individuals find relief through alternative therapies such as acupuncture, chiropractic care, or biofeedback, but their effectiveness varies.
Seek specialist care: This condition is best managed by neurologists or pain specialists with experience in trigeminal neuralgia.