Trigeminal neuralgia: Symptoms, Causes & Treatment

 What is trigeminal neuralgia?

Trigeminal neuralgia, likewise known as Tic Douloureux, is a chronic pain sensation felt in the face (especially the lower face, jaw, nose, ears, lips, and eyes) that is caused by disruption of trigeminal nerve functions. The trigeminal nerve is the fifth cranial nerve, which is made up of 3 nerve branches; Ophthalmic, Maxillary, and Mandibular. 

The trigeminal nerve is responsible for your facial sensations and motor functions involving the mouth. It affects a human’s ability to chew, bite, and move the mouth. Trigeminal neuralgia is one of the most painful conditions that is seen mostly in women above 50 years of age but can occur in men as well.

Trigeminal neuralgia occurs in 1 in every 8000 people per year worldwide. The exact cause is not so clear, but it is presumed to be caused by any factor that can compress the nerve or affect the nerve’s ability to function properly.

Classifications Of Trigeminal Neuralgia:

There are two types of trigeminal neuralgia:

  1. Typical trigeminal neuralgia: Is a form of Tic Douloureux that occurs in episodes of sudden, severe shock-like shooting pain on one side of the face. The pain lasts for a couple of seconds to minutes and could go on in episodes for a couple of hours.
  2. Atypical trigeminal neuralgia: Occur as a constant, less severe burning facial pain that occurs as spasms of pain that spread to the entire face gradually. The pain usually starts after a feeling of a tingling sensation on the face or numbness of the whole face. 

Typical and Atypical trigeminal neuralgia can be triggered by:

  • Chewing
  • Touching the face (putting on makeup, washing the face or shaving)
  • Speaking
  • Brushing the teeth
  • Smiling
  • Drinking

What are the symptoms of trigeminal neuralgia?

The symptoms of trigeminal neuralgia may occur as a severe facial pain that lasts for a few seconds or minutes. This is one of the most painful conditions ever. It is often accompanied by shooting pain that may feel like an electric shock of the face. Usually, the pain occurs on one side of the face. Although in some patients, the pain may occur on different sides of the face alternately, and at different times, patients describe it as constant aching, burning, pinching, piercing, or feeling like ants on the skin. 

The pain may occur in the cheek, jaw, teeth, lips, gums, including the eye and forehead, depending on which location that the trigeminal nerve is affected.

What causes Trigeminal Neuralgia?

  • A pressure on the root of the trigeminal nerve by blood vessels (contact between the trigeminal nerve root and a blood vessel can trigger spastic facial pain).
  • A tumor pressing on the trigeminal nerve
  • Aging (usual onset is 50 years and above)
  • Multiple sclerosis (a disorder where the myelin sheath protecting certain nerves are damaged).
  • Stroke
  • Other facial trauma or surgical injuries

How is Trigeminal Neuralgia diagnosed?

  • Neurological examination: examines nerve function (check the presence or absence of reflexes and sensations)
  • Magnetic resonance imaging (MRI): check for the presence of multiple sclerosis or tumor and eliminate any other possible disorder that may cause facial pain. 
  • Magnetic resonance angiogram: examines the flow of blood in vessels.
  • CT scan: is used in cases where there is a history of head trauma.

Treatment Of Trigeminal Neuralgia:

For the conservative treatment of trigeminal neuralgia, the following medicines are used:

  • Anticonvulsant medications such as Carbamazepine, Gabapentin, Phenytoin, Valproic acid, and Topiramate are used to block the pain and promote relief.
  • Anti-spasticity: Baclofen is used to relax the surrounding muscle.
  • Alcohol can also be injected into areas of pain to numb the areas.

Surgery is done to kill off the nerve entirely or relieve the pressure put on the nerve by a tumor or blood vessel. If medications do not provide relief or cause severe side effects.