What is Trigeminal Neuralgia?
Trigeminal neuralgia (TN) is a chronic pain condition that affects the trigeminal or 5th cranial nerve, one of the most important nerves in the head and neck, responsible for providing sensation to the entire face. The condition is a form of neuropathic pain (pain associated with nerve injury or nerve lesion.)
The trigeminal nerve is one of 12 pairs of nerves that are attached to the brain. The nerve has three branches that conduct sensations from the upper, middle, and lower portions of the face, as well as the oral cavity, to the brain. More than one nerve branch can be affected by the disorder. Rarely, both sides of the face may be affected at different times in an individual, or even more rarely at the same time (called bilateral TN).
TN can be caused by a blood vessel pressing on the trigeminal nerve as it exits the brain stem. This compression causes the wearing away or damage to the protective coating around the nerve (the myelin sheath). TN symptoms can also occur in people with multiple sclerosis, a disease that causes deterioration of the trigeminal nerve’s myelin sheath. Rarely, symptoms of TN may be caused by nerve compression from a tumor, or a tangle of arteries and veins called an arteriovenous malformation. Injury to the trigeminal nerve (perhaps the result of sinus surgery, oral surgery, stroke, or facial trauma) may also produce neuropathic facial pain.
TN is a rare condition and, according to the National Institute of Neurological Disorders and Stroke, the incidence of new cases is approximately 12 per 100,000 people per year. It is more common in women, and patients are typically middle-aged or seniors.
Types of Trigeminal Neuralgia
Trigeminal neuralgia is usually categorized as typical or atypical, with symptoms differing depending on the type:
- Typical: With typical TN, the most common form, patients suffer from unpredictable episodes of stabbing, electric shock-like pain in a consistent location. The pain can be reproduced by touching a “trigger point” on the face or performing a certain activity, such as chewing or talking.
- Atypical: Patients with atypical TN experience a persistent dull ache or burning sensation in one part of the face. However, episodes of sharp pain can complicate atypical TN. Unlike typical TN, there is often not a specific trigger point for the pain and it can grow worse over time.
Symptoms & Diagnosis
Severe pain is the number one symptom associated with TN. The devastating condition causes patients extreme, and often debilitating, pain and is commonly referred to as the “suicide disease” due to the level of excruciating pain experienced by patients who suffer from the condition. The pain varies and may range from sudden, severe, and stabbing to a more constant, aching, burning sensation. The pain can be triggered by vibration or contact with the cheek (such as when shaving, washing the face, or applying makeup), brushing teeth, eating, drinking, talking, or being exposed to the wind. It may affect a small area of the face or may spread. If you experience facial pain, particularly prolonged or recurring pain or pain unrelieved by over-the-counter pain relievers, please see your physician.
TN can be very difficult to diagnose because there are no specific diagnostic tests and symptoms are very similar to other facial pain disorders. The condition can often be mistaken for a dental problem since the disorder usually causes sharp pain in the jaw. Diagnosis sometimes takes several years, as patients may undergo root canals or tooth extractions in an attempt to relieve their pain. If you experience unusual, sharp pain around the eyes, lips, nose, jaw, forehead, or scalp, and you have not had dental or other facial surgery recently, address the problem with your primary care physician. Your physician may refer you to a specialist. Most people with TN eventually will undergo a magnetic resonance imaging (MRI) scan to rule out a tumor or multiple sclerosis as the cause of their pain. This scan may or may not clearly show a blood vessel compressing the nerve. Special MRI imaging procedures can reveal the presence and severity of compression of the nerve by a blood vessel.
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