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Trigeminal neuralgia, also known as tic douloureux, is a facial pain condition that causes the sufferer to experience sharp jolts of facial pain that feel like electrical shocks. The pain typically only affects one side of the face, but in rare cases pain can occur on both sides of the face. Individuals who suffer from trigeminal neuralgia can experience episodes of pain as a result of mild facial stimulation, such as:
- Brushing their teeth
- Applying makeup
- Touching their face
In some cases, the feeling of a light breeze on the individuals face can trigger a painful episode. This makes living with trigeminal neuralgia incredibly difficult and can lead to a significant decrease in quality of life.
The pain caused by trigeminal neuralgia is commonly described as sharp, sudden, and severe. While most people describe the pain as being similar to an electrical shock, others have described the pain as a stabbing, crushing, or shooting pain that can be extremely difficult to manage.
Trigeminal neuralgia typically occurs in episodes that can last for seconds, minutes, or hours. The frequency of these episodes can vary greatly. The number of episodes a patient experiences can range from just a handful to over 50 per day. Classically, patients experience “pain free” episodes between the attacks of electrical shock, meaning they have no pain between attacks. But there is also a variant called “Type II Trigeminal Neuralgia” in which patients have underlying chronic pain in the face, that is there more than 50% of the time. The pain of trigeminal neuralgia can wax and wane over time, and can sometimes go away for months or years before coming back.
The trigeminal nerve is the main nerve that gives sensation to the face. Each nerve (one on each side) separates into three main branches that spread across the upper and lower face.
While the exact cause of trigeminal neuralgia is still not completely understood, there are many theories about what causes the pain. In some cases, a blood vessel may run right next to the nerve where it comes out of the brain. The pulsation of this blood vessel can irritate the nerve and cause pain. The pulsations can cause damage to the protective sheath around the nerve and may cause the nerve to become hyperactive. Other potential causes of trigeminal neuralgia include:
- Multiple sclerosis
- Brian lesions and abnormalities
It is important to recognize that not all facial pain is necessarily trigeminal neuralgia. We differentiate the different types of facial pain based on history, pattern and sensation of pain, associated symptoms, and response to treatment. Other causes of facial pain include:
- Atypical facial pain
- Trauma to the face
- Cluster headache and other trigeminal autonomic cephalalgias
Like many other pain syndromes, treatment of trigeminal neuralgia is initiatied after making a diagnosis and when symptoms become bothersome. First line therapies include medications such as carbamazepine (tegretol) or oxcarbazepine (trileptal). Other medications that can be tried include baclofen, gabapentin, and lyrica.
When medications are inadequate, we consider surgical interventions. The gold standard therapy is a surgery called microvascular decompression (MVD), in which a brain surgery is done to move the blood vessel off of the nerve. However, MVD is not the best option for all patients, depending on symptoms, age, and general health. Other options include more minimally invasive surgical options like percutaneous balloon compression and radiofrequency ablation as well as stereotactic radiosurgery. Each procedure has specific advantages and limitations, including how quickly it works, success rates, side effects, and risk of recurrence after a successful treatment.