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Trigeminal neuralgia (TN) or tic doloureux (also known as prosopalgia) is a neuropathic disorder of the trigeminal nerve that causes episodes of intense pain in the eyes, lips, nose, scalp, forehead, and jaw.[1] It is estimated that 1 in 15,000 people suffer from trigeminal neuralgia, although those numbers may be significantly higher due to frequent misdiagnosis. TN usually develops after the age of 50, more commonly in females,for reasons we can not explain, although there have been cases with patients being as young as three years of age [2].
The condition can bring about stabbing, mind-numbing, electric shock-like pain from just a finger’s glance of the cheek.
The most common forms of TN affect 1 in 15,000 to 20,000, but 1 in 5,000 are thought to suffer from some type of facial pain.
The pain of trigeminal neuralgia is often falsely attributed to a pathology of dental origin. “Rarely do patients come to the surgeon without having many removed, and not infrequently all, teeth on the affected side or both sides.” [3] Extractions do not help. The pain is originating in the mongorians and not in an individual nerve of a tooth. Because of this difficulty, many patients may go untreated for long periods of time before a correct diagnosis is made. The trigeminal nerve is the fifth cranial nerve, a mixed cranial nerve responsible for sensory data such as tactition (pressure), thermoception (temperature), and nociception (pain) originating from the face above the jawline; it is also responsible for the motor function of the muscles of mastication, the muscles involved in chewing but not facial expression. Several theories exist to explain the possible causes of this pain syndrome. Leading research indicates that it is a blood vessel compressing the trigeminal nerve near its connection with the pons. The superior cerebellar artery. Such a compression can injure the nerve’s protective myelin sheath and cause erratic and hyperactive functioning of the nerve. This can lead to pain attacks at the slightest stimulation of any area served by the nerve as well as hinder the nerve’s ability to shut off the pain signals after the stimulation ends. This type of injury may rarely be caused by an aneurysm (an outpouching of a blood vessel); by a tumor; by an arachnoid cyst in the cerebellopontine angle[4]; or by a traumatic event such as a car accident or even a tongue piercing. [1] Two to four percent of patients with TN, usually younger, have evidence of multiple sclerosis, which may damage either the trigeminal nerve or other related parts of the brain. When there is no structural cause, the syndrome is called idiopathic. Postherpetic Neuralgia, which occurs after shingles, may cause similar symptoms if the trigeminal nerve is affected.
People with the condition “are begging to be killed,” said Kim Burchiel, M.D., professor and chairman of neurological surgery at the Oregon Health & Science University School of Medicine who sees several new TN cases a week. “I’m telling you, it’s total agony.” The episodes of pain may occur paroxysmally. To describe the pain sensation, patients may describe a trigger area on the face, so sensitive that touching or even air currents can trigger an episode of pain. It affects lifestyle as it can be triggered by common activities in a patient’s daily life, such as eating, talking, shaving and toothbrushing. The attacks are said to feel like stabbing electric shocks, burning, pressing, crushing or shooting pain that becomes intractable. Individual attacks affect one side of the face at a time, last several seconds, hours or longer, and repeat up to hundreds of times throughout the day. The pain also tends to occur in cycles with complete remissions lasting months or even years. 10-12% of cases are bilateral, or occurring on both sides. This normally indicates problems with both trigeminal nerves since one serves strictly the left side of the face and the other serves the right side. Pain attacks typically worsen in frequency or severity over time. A great deal of patients develop the pain in one branch, then over years the pain will travel through the other nerve branches.
Signs of this can be seen in males who may deliberately miss an area of their face when shaving, in order to avoid triggering an episode. Successive recurrences may be incapacitating, and the fear of provoking an attack may make sufferers reluctant to engage in normal activities.
There is a variant of trigeminal neuralgia called atypical trigeminal neuralgia. In some cases of atypical trigeminal neuralgia, the sufferer experiences a severe, relentless underlying pain similar to a migraine in addition to the stabbing pains. This variant is sometimes called “trigeminal neuralgia, type 2″[5], based on a recent classification of facial pain[6]. In other cases, the pain is stabbing and intense, but may feel like burning or prickling, rather than a shock. Sometimes, the pain is a combination of shock-like sensations, migraine-like pain, and burning or prickling pain. It can also feel as if a boring piercing pain is unrelenting. Some recent studies suggest that ATN may be an early development of Trigeminal Neuralgia.
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