Summary about Disease
Trigeminal neuralgia (TN), also known as tic douloureux, is a chronic pain condition that affects the trigeminal nerve, which carries sensation from your face to your brain. It causes episodes of intense, stabbing, electric shock-like pain in the face. These attacks can be triggered by simple activities like touching the face, eating, speaking, or even exposure to a breeze.
Symptoms
Episodes of severe, shooting, stabbing, or electric shock-like pain.
Pain typically felt on one side of the face.
Pain focused in areas supplied by the trigeminal nerve, such as the cheek, jaw, teeth, gums, lips, or less commonly the eye and forehead.
Attacks triggered by touching the face, chewing, speaking, brushing teeth, or exposure to wind.
Bouts of pain lasting from a few seconds to a few minutes.
Pain-free periods between attacks, which may shorten over time.
Possible aching, burning sensation that may occur before evolving into the intense pain of trigeminal neuralgia.
Causes
Nerve Compression: In most cases, trigeminal neuralgia is caused by a blood vessel (artery or vein) pressing on the trigeminal nerve as it exits the brainstem. This pressure damages the protective myelin sheath around the nerve.
Multiple Sclerosis (MS): In some cases, TN is associated with multiple sclerosis, a disease that damages the myelin sheath of nerves in the brain and spinal cord.
Tumors: Rarely, a tumor can compress the trigeminal nerve.
Other Causes: In some cases, the cause is unknown (idiopathic).
Medicine Used
Anticonvulsants: Carbamazepine and oxcarbazepine are commonly used to reduce nerve firing and block pain signals.
Muscle Relaxants: Baclofen can be used alone or in combination with anticonvulsants.
Tricyclic Antidepressants: Amitriptyline or nortriptyline can sometimes help with chronic pain.
Other Medications: Gabapentin, pregabalin, clonazepam, and other medications may be used in some cases.
Botulinum Toxin (Botox) Injections: In some cases, Botox injections into the affected facial muscles can provide pain relief.
Is Communicable
Trigeminal neuralgia is not communicable. It is not an infectious disease and cannot be spread from person to person.
Precautions
Identify and Avoid Triggers: Keep a diary to note what activities or stimuli trigger your pain, and try to avoid them.
Soft Diet: If chewing triggers pain, a soft diet may be necessary during episodes.
Oral Hygiene: Maintain good oral hygiene, even if brushing is painful. Use a soft toothbrush and consider mouthwash if necessary.
Protect Face from Wind: In cold or windy weather, protect your face with a scarf or mask.
Manage Stress: Stress can sometimes exacerbate pain. Practice relaxation techniques like deep breathing or meditation.
Regular Doctor Visits: Maintain regular appointments with your neurologist or pain specialist to manage your condition.
How long does an outbreak last?
The duration of a trigeminal neuralgia "outbreak" or episode can vary greatly.
Acute Attacks: Individual attacks of pain typically last from a few seconds to a few minutes.
Episodes: Bouts of frequent attacks can last for days, weeks, or even months.
Remission: Pain-free periods (remissions) can also vary in length, lasting for months or even years.
Progression: Over time, the condition may become more frequent and severe, with shorter remission periods.
How is it diagnosed?
Medical History: The doctor will ask about your symptoms, triggers, and medical history.
Neurological Examination: A neurological exam will assess your reflexes, sensation, and nerve function.
MRI (Magnetic Resonance Imaging): An MRI of the brain can help to rule out other conditions, such as tumors or multiple sclerosis, and to identify if a blood vessel is compressing the trigeminal nerve.
Diagnosis of Exclusion: Trigeminal neuralgia is often diagnosed based on the characteristic symptoms and after excluding other possible causes of facial pain.
Timeline of Symptoms
The timeline of trigeminal neuralgia symptoms can vary, but a general progression might look like this:
Initial Onset: Infrequent, mild episodes of facial pain.
Progression: Episodes become more frequent, severe, and longer-lasting.
Triggers Emerge: Specific triggers (touch, chewing, wind) become apparent.
Remission and Relapse: Periods of remission (pain-free intervals) alternate with periods of active pain.
Chronic Pain: Over time, the remission periods may shorten, and the pain may become more constant, with acute exacerbations.
Important Considerations
Quality of Life: Trigeminal neuralgia can significantly impact quality of life due to the intensity and unpredictability of the pain.
Mental Health: Chronic pain can lead to depression, anxiety, and social isolation. Addressing mental health is an important part of management.
Treatment Options: A range of treatment options are available, including medication, surgery, and complementary therapies. Finding the most effective treatment plan may require trial and error.
Surgical Options: When medication is not effective, surgical options like microvascular decompression (MVD) or radiofrequency ablation may be considered.
Second Opinions: It's often beneficial to seek a second opinion from a neurologist or pain specialist experienced in treating trigeminal neuralgia.