Trigeminal neuralgia (TN), also called tic douloureux, is a chronic pain disorder of the trigeminal nerve, or the fifth cranial nerve. This nerve is one of 12 pairs of nerves that are attached to the brain. Pain caused by this condition can affect the jaw, teeth, gums, lips, cheek, forehead, or eye.
There are two main types of TN: typical and atypical.
The typical form (Type 1, or TN1) manifests in sudden, short, extreme bursts of pain, resembling a feeling of burning or electrical shock on one side of the face. The episodes last from seconds to a few minutes, and they can occur in a series over several hours.
The atypical form (Type 2, or TN2) causes burning, aching, stabbing pain that is less extreme than T1 but is constant.
Both forms may occur in the same person. Any touch or sensation to the face can trigger an attack, such as brushing your teeth or washing your face. The slightest stimulation on the face, even smiling, can trigger pain and hinder the nerve’s ability to shut off pain signals.
The disorder is not fatal, but it can be debilitating, as it can lead to anxiety and depression.
What Is the Trigeminal Nerve?
The trigeminal nerve is a cranial nerve with three major branches:
- The ophthalmic, or upper, branch supplies sensation to the scalp and the front of the head.
- The maxillary, or middle, branch stimulates upper jaw, cheek, top lip, teeth, gums, and the side of the nose.
- The mandibular, or lower, branch supplies nerve sensation to the teeth, gums, bottom lip, and lower jaw.
This multifunctional cranial nerve senses and processes pressure, temperature, and pain in the face. It also controls the muscles involved in chewing.
One, two, or all three nerve branches may be affected by trigeminal neuralgia. TN most commonly involves the middle (maxillary) or lower (mandibular) branches.
In rare cases, both sides of the face may be affected at different times or, even more seldom, simultaneously. This is called bilateral TN.
What Causes Trigeminal Neuralgia?
There are several main causes of trigeminal neuralgia, including the following:
- Loss or disruption of the protective fatty sheath known as myelin surrounding the nerves, which can include the trigeminal nerve – this can cause the nerve to become hyperactive and function erratically
- Multiple sclerosis (MS), which is a condition that is caused by scars (sclerosis) forming in the protective myelin layer – if this protection is lost, the nerve can be exposed
- Contact between a blood vessel and the nerve, or if the blood vessel is putting pressure against the nerve
- A tumor putting pressure against the nerve
- Normal aging
Other conditions that can cause TN include:
- Genetic causes – TN may run in families
- Herpes zoster (shingles)
- High blood pressure
- Injury or trauma from an accident, sinus or oral surgery, or a stroke
When no cause can be detected, the TN syndrome is called idiopathic.
Triggers of Trigeminal Neuralgia
A variety of ordinary daily activities may trigger trigeminal neuralgia pain, including:
- Brushing teeth
- Drinking
- Eating
- Exposure to breeze or wind
- Facial makeup or cosmetics
- Shaving
- Smiling
- Talking
- Touching your face
- Washing your face
Pain can also occur without any apparent stimulation or trigger.
Pain in Trigeminal Neuralgia
The variants of TN are distinguishable by their causes, like trauma, disease, or dental treatments. So the types of pain can be different as well. It is important to distinguish the cause of your TN, as treatment recommendations differ for each.
- The pain attacks are described as:
- Stabbing electric shocks
- Uncontrollable burning
- Sharp, crushing pressure
- Exploding or shooting pain
The pain is cyclical, with remissions that may last for months or even years.
Pain attacks can become worse or more frequent over time, and they may even migrate to other nerve branches. However, they can remain very stable in many other cases.
Diagnosis, Treatment, and Management of Trigeminal Neuralgia
TN usually manifests at 50 years of age or older, but it can occur at any age. Younger people with TN usually experience the condition due to underlying multiple sclerosis. Interestingly, more women than men get TN.
TN is often misdiagnosed because a TN sufferer will likely consult numerous other clinicians, rather than a neurologist, to discover the cause of their symptoms. A firm diagnosis is based on the symptoms, medical history, and neurological and physical tests which have ruled out other possible causes.
Treatment includes medication with anticonvulsants and antidepressants, or even surgery if necessary.
TN should be diagnosed and treated as soon as possible. The longer a patient suffers, the harder it may be to reverse the neural pathways associated with the pain via medications.
There are many medications available to help treat TN. Surgery is recommended only after medications have failed, or if side effects of the medications are not tolerated well. While surgery may provide pain relief, it also carries significant risks of consequences such as facial numbness.
Who Can Help With My Nerve Pain?
CyberKnife Radiation Therapy is one of the easiest and most successful treatments available for Trigeminal Neuralgia. Often eliminating pain with just one, non-invasive CyberKnife Treatment Session. If you experience prolonged, recurring facial pain that is not relieved by over-the-counter pain medications, call the CyberKnife Center of Miami at (800) 204-0455 or (305) 279-2900 to schedule an appointment with one of our specialists, or fill out our online contact form today. We look forward to helping you achieve a more pain-free life.