Trigeminal Neuralgia

What is Trigeminal Neuralgia?

Trigeminal neuralgia is an ongoing pain condition that affects the nerves of the face. Commonly abbreviated as TN, trigeminal neuralgia is also called tic douloureux. This roughly translates to “painful twitching,” due to the uncontrollable facial twitching caused by pain. Trigeminal neuralgia is classified by extreme, sporadic, sudden burning or shock-like facial pain.

TN is known as a form of neuropathic pain, meaning that the discomfort it causes stems from nerve injury or nerve lesion. TN comes in two types: TN1 and TN2. While symptoms are similar, there is one major difference.

• Type 1 (TN1): Also called the “classic” form of the disorder, TN1 causes extreme, sudden facial pain that will vary from a few seconds long to as long as two minutes per episode. These episodes can occur in rapid succession and can repeat for up to two hours.
• Type 2 (TN2): Also called the “atypical” form of trigeminal neuralgia, TN2 is characterized by a constant burning, aching, or stabbing pain. While this pain may not be as intense as TN1, it is an ever-present duller ache.

An individual can suffer from both forms of TN, and it is possible to experience both at the same time. The intensity of pain can be physically and mentally incapacitating, hence why TN has been dubbed “the suicide disease.”

Tracking the Trigeminal Nerve

Trigeminal neuralgia is triggered by an irritation of the trigeminal nerve. The trigeminal nerve is one of the 12 pairs of cranial nerves located within the head, and it supplies feeling and movement to the face. The trigeminal nerve begins in the brain stem inside of the skull, and runs down each side of the head. The nerves divide into three branches, which then exit the skull to provide sensation to the face.

The three branches of the trigeminal nerve include:

• The Ophthalmic Branch: controls the eye, upper eyelid, and forehead.
• The Maxillary Branch: affects the lower eyelid, cheek, nostril, upper lip, and upper gum.
• The Mandibular Branch: controls the jaw, lower lip, lower gum, and some muscles utilized for chewing.

Trigeminal neuralgia can affect any of the three nerve branches, meaning it’s possible to feel pain from the forehead to the jaw. Typically, pain is only felt on one side of the face, however, some people do feel it on both sides. When this happens, the condition is known as bilateral trigeminal neuralgia.

What Causes Trigeminal Neuralgia?

The trigeminal nerve arises from the brain stem, which is located at the base of the brain and is continuous with the spinal cord. Trigeminal neuralgia begins when this nerve becomes irritated at the root. Irritation can have a variety of causes, including:

• Blood Vessel: A blood vessel can press on the trigeminal nerve, damaging the protective coating around it, the myelin sheath.
• Disease: Certain diseases, such as multiple sclerosis, can also injure the myelin sheath. A tumor can also press on the nerve.
• Injury: Surgery or an accident can place pressure on the nerve.
• Stroke: Suffering a stroke can damage the trigeminal nerve.

Symptoms of Trigeminal Neuralgia

Many describe a TN attack as pins and needles or tingling sensations that evolves into a jabbing or burning pain, or as an electric shock that lasts a few seconds to a few minutes. Common symptoms of trigeminal neuralgia include:

• Recurring episodes of shooting pain similar to electric shocks
• Stabbing or shooting pain
• A burning sensation on one side of the face
• Pain spasms that last from several seconds to a few minutes
• Intermittent spasms of mild pain
• Pain in the gums, teeth, jaw, and lips
• Pain on one or both sides of the face
• Numbness in the face
• Attacks which worsen over time

Some individuals who suffer TN are sensitive in certain areas of the face, called trigger zones. When touched, these zones bring on an attack. For most people, these zones are near the nose, lips, eyes, ear, or inside the mouth. For this reason, TN is sometimes misdiagnosed as a dental or jaw problem or even as a psychological disorder.

Triggers for Trigeminal Neuralgia Facial Pain

For those with trigger zones, even the slightest touch can cause an episode. Once a person has trigeminal neuralgia, pain episodes can be triggered by contact with the cheek or jaw. Episodes can also be brought on by vibration. This is why many with TN avoid electric toothbrushes, as the vibration of the toothbrush head can trigger an attack.

Who is at Risk of Developing Trigeminal Neuralgia?

Generally speaking, those over the age of 50 are at most risk of developing trigeminal neuralgia. However, TN can occur at any age including infancy, though rare. The possibility of TN being caused by multiple sclerosis increases when it occurs in young adults. Overall, trigeminal neuralgia is more common in women than men.

Today, the incidence of new cases of TN is approximately 12 per 100,000 people per year.

How is Trigeminal Neuralgia Diagnosed?

The facial pain caused by trigeminal neuralgia is typically how physicians are able to diagnose the condition. TN is detected once a patient has tried and is not responding to traditional over-the-counter pain relievers, and pain has been consistent for one month or longer. A physician will conduct a neurological exam, this is when the physician touches parts of the face along the trigeminal nerve to deduce if it is creating pain.

A physician will also test your reflexes to determine if a nerve is compressed. Medical image testing such as an MRI may be used to examine if a tumor or condition such as multiple sclerosis is the underlying cause of your problem.

Treatment Options for Trigeminal Neuralgia

Many conventional methods of TN treatment are not only expensive but also incredibly invasive. Not to mention, many of these treatments have adverse side effects that can further impact a patient’s quality of life.

Medical treatment for TN includes:

• Nerve inhibitors to limit nerve reaction
• Muscle relaxers
• Antidepressants

Surgical intervention for TN includes:

• Micro-vascular decompression, in which blood vessels affecting the nerve are moved or removed
• Gamma knife radiosurgery, which uses radiation to destroy some of the nerves
• Balloon compression, which uses a balloon to damage the nerve and block pain signals
• Rhizotomy, which destroys nerve fibers

Aside from gamma knife surgery, which uses damaging radiation, these surgeries all utilize a large, hollow needle to pierce through the face into an opening in the base of the skull. These invasive procedures are not only frightening, but can damage neighboring nerves, creating lifelong damage.

Alternative Treatment Options for Trigeminal Neuralgia

There are less invasive methods of reducing nerve pain and stress in the face. Some alternative complementary therapies include:

• Acupuncture
• Aromatherapy
• Meditation
• Yoga

Chiropractic Care for Trigeminal Neuralgia