Summary about Disease
Tic Douloureux, also known as trigeminal neuralgia, is a chronic pain condition that affects the trigeminal nerve, which carries sensation from your face to your brain. It causes sudden, severe facial pain that feels like an electric shock. It typically affects one side of the face and can be triggered by common activities such as touching your face, eating, drinking, or even a breeze.
Symptoms
Episodes of severe, shooting or jabbing pain that may feel like an electric shock
Spontaneous attacks of pain or attacks triggered by touching the face, chewing, speaking or brushing teeth
Bouts of pain lasting from a few seconds to several minutes
Pain usually felt on one side of the face at a time
Pain focused in the cheek, jaw, teeth, gums, lips, or less often the eye and forehead
Attacks that become more frequent and intense over time
Possible constant aching, burning feeling that might occur before it evolves into the tic-like pain.
Causes
The cause of trigeminal neuralgia is often difficult to determine. It's frequently related to:
Blood vessel pressing on the trigeminal nerve: The most common cause is a blood vessel (usually an artery or vein) pressing on the trigeminal nerve as it exits the brainstem. This pressure can damage the protective myelin sheath around the nerve.
Multiple sclerosis (MS): MS can damage the myelin sheath of nerves, including the trigeminal nerve.
Tumor: Rarely, a tumor can press on the trigeminal nerve.
Other causes: In some cases, trigeminal neuralgia can be caused by other conditions or may have no identifiable cause.
Aging: Trigeminal neuralgia is more common in people over the age of 50.
Medicine Used
Anticonvulsants: Carbamazepine (Tegretol) and oxcarbazepine (Trileptal) are often the first-line medications. These medications help to block nerve signals and reduce pain.
Muscle Relaxants: Baclofen (Lioresal) can be used alone or in combination with carbamazepine or oxcarbazepine.
Tricyclic Antidepressants: Amitriptyline or nortriptyline can be used for pain management.
Other medications: Gabapentin, pregabalin, clonazepam, lamotrigine, and phenytoin may also be used.
Botulinum toxin (Botox) injections: Botox injections may reduce pain in some people.
Painkillers: Opioid pain relievers aren't usually effective in treating trigeminal neuralgia because the pain is neuropathic.
Is Communicable
No, trigeminal neuralgia is not communicable. It is not an infectious disease and cannot be spread from person to person.
Precautions
While you cannot prevent trigeminal neuralgia, you can take precautions to manage symptoms and reduce triggers:
Avoid triggers: Identify and avoid activities or stimuli that trigger your pain (e.g., cold air, specific foods, certain facial movements).
Soft diet: If chewing triggers pain, eat soft foods that require less chewing.
Protect your face: In cold weather, wear a scarf to protect your face from the wind.
Gentle hygiene: Use a soft toothbrush and brush gently if oral hygiene triggers pain.
Stress management: Practice stress-reduction techniques, such as meditation or yoga, as stress can worsen pain.
Regular doctor visits: Follow up with your doctor regularly to monitor your condition and adjust your treatment plan as needed.
How long does an outbreak last?
The duration of pain episodes in trigeminal neuralgia can vary widely. Some individuals may experience pain for just a few seconds, while others may have attacks that last for several minutes. These attacks can occur sporadically or in clusters, with periods of remission in between. The frequency and duration of attacks can change over time. Some may experience long periods without pain, only to have the pain return later. Others may experience chronic, persistent pain with occasional flare-ups.
How is it diagnosed?
Diagnosis of trigeminal neuralgia is primarily based on:
Medical history: Your doctor will ask about your symptoms, including the location, type, and triggers of your pain.
Neurological examination: A neurological exam can help rule out other conditions and assess nerve function.
MRI (Magnetic Resonance Imaging): An MRI of the brain can help identify potential causes of trigeminal neuralgia, such as a blood vessel pressing on the nerve or a tumor. It can also help rule out other conditions, such as multiple sclerosis.
Timeline of Symptoms
The timeline of trigeminal neuralgia symptoms can vary significantly from person to person. However, a general progression often looks like this:
Initial stage: Infrequent, mild attacks of facial pain that are often mistaken for dental pain or sinus problems.
Progression: As the condition progresses, the attacks become more frequent and intense. The pain may last longer, and the triggers may become more varied.
Chronic stage: In some cases, the pain becomes chronic, with persistent aching or burning in addition to the sharp, stabbing pain. Periods of remission may become shorter or less frequent.
Plateau: Eventually, the condition may plateau, with the pain remaining relatively stable over time. However, the pain is often still debilitating and can significantly impact quality of life.
Important Considerations
Mental Health: Chronic pain conditions like trigeminal neuralgia can significantly impact mental health. Depression, anxiety, and sleep disturbances are common. It's important to seek support from a mental health professional if needed.
Dental Health: Due to the facial pain, dental hygiene can be difficult. Gentle brushing and regular dental checkups are important to prevent dental problems.
Medication Side Effects: Be aware of the potential side effects of medications used to treat trigeminal neuralgia and discuss any concerns with your doctor.
Surgical Options: If medications are not effective, surgical options may be considered. These options include microvascular decompression, stereotactic radiosurgery (Gamma Knife), and other procedures to relieve pressure on the trigeminal nerve.
Alternative Therapies: Some people find relief from alternative therapies, such as acupuncture, chiropractic care, or massage. However, the effectiveness of these therapies for trigeminal neuralgia is not well-established. Always consult with your doctor before trying any alternative therapies.