About Trigeminal Neuralgia

What is Trigeminal Neuralgia?

Trigeminal neuralgia (TN), also known as tic dioloureux, is an extremely painful condition that involves the trigeminal nerve, the fifth cranial nerve. The trigeminal nerve has three branches:

  • The ophthalmic branch leads to the eye and forehead area.
  • The maxillary branchleads to the areas around the cheekbone and the side of the nose.
  • The mandibular branch covers the area from the lower jaw to above the ear.

Trigeminal neuralgia is "associated with compression of the trigeminal sensory root by blood vessels, but it can also be associated with other structural lesions of the 5th nerve, and it occurs fairly frequently in patients with multiple sclerosis." (Gelb 280) Occurrences are more common in women than men (a ratio of 3:2) and among people over fifty. (Adams and Victor 1171)

The pain is generally described as feeling like an electric shock; a lightning flash; or a searing, jabbing, or stabbing pain. An episode will usually last a few seconds but can repeat several times and can be severe. Attacks are unpredictable and may occur for weeks or months. The same periods of time without pain may also occur just as unpredictably. There can also be one or more external factors that can trigger attacks: eating or drinking, brushing teeth or hair, shaving, putting on makeup, washing the face with cold water, cold air on the face, lightly touching the skin on the side of the face, or talking.

Methods of Treatment

Drugs are usually the first line of treatment. "The drug carbamazepine (Tegretol), which stabilizes irritable nerve membranes, is effective for many individuals." (Morris, Pedley, and Rowland 687) Other methods include, but are not limited to, glycerol injection, gamma knife radiosurgery, and microvascular decompression. "Twenty-five to 50% of patients will eventually stop responding to drug therapy and may need surgery." (Health Resources) About 85% of patients who elect to have surgery realize significant pain relief. (Health Resources)

Resources

Adams, Raymond D., and Victor, Maurice. Principles of Neurology. New York: McGraw-Hill, 1993.

Gelb, Douglas J. Introduction to Clinical Neurology. Boston: Butterworth-Heinemann, 1995.

Morris, James R., Pedley, Timothy A., and Rowland, Lewis P. "Trigeminal Neuralgia (Nerve Disorders) in The Columbia University College of Physicians & Surgeons Complete Home Medical Guide. Edition 3, : Crown, 1995.

"Trigeminal Neuralgia," in Health Resources: Neurosurgery://On-Call [Web Site], December 2001; available from http://www.neurosurgery.org.