Trigeminal Neuralgia

Trigeminal Neuralgia is a disorder of the trigeminal nerve (fifth cranial nerve) that causes severe, shooting pain along one side of the face. The Trigeminal nerve is one of the largest nerves in the head. It senses touch, pain, pressure, and temperature. It also helps make saliva and tears. In Trigeminal Neuralgia pain usually lasts for a few seconds and may come and go for days, weeks, or months. It may go into remission or stop completely for months or years. Over time, though, the attacks usually become more frequent and more severe. Attacks can be brought on by chewing, washing, shaving, touching, or even a breeze on the face.

Causes

The exact causes are unclear. Possible causes may include:
  • Degeneration of the nerve
  • Pressure on the nerve
  • Irritation of the nerve
  • An abnormally formed artery running too close to the nerve
These possible causes are rare:
  • Tumor in the brain or head
  • Multiple sclerosis
  • Shingles

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.
  • Age: 50 or older
  • Sex: Female (a slightly higher risk)

Symptoms

The main symptom is pain on one side of the face. The pain may be felt inside the mouth or in the lips, cheek, chin, nostril, ear, or near the eye. Rarely, pain may occur in the eye or forehead. Twitching or wincing sometimes accompanies the pain.
Other symptoms may include:
  • Pain that is sudden, severe, and stabbing
  • Pain attacks that last less than two minutes
  • Attacks that occur up to hundreds of times in a day
  • Successive attacks that may be disabling
  • Attacks that may be triggered by washing, shaving, touching, or tickling the face
There are usually no symptoms between attacks. However, some people may feel a dull ache between attacks.

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam.
Tests may include:
CT Scan – a type of x-ray that uses a computer to make pictures of structures inside the head
MRI Scan – a test that uses magnetic waves to make pictures of structures inside the head
You may be given carbamazepine. This drug reduces the pain and is sometimes used to help diagnose the disorder.

Treatment

Treatment usually begins with medication. If medication fails, other options are available.
Medications
Medications may include:
  • Carbamazepine
  • Phenytoin
  • Other anticonvulsants
  • Antidepressants
  • Baclofen
Surgery
Surgical options include:
  • Surgery to remove an artery or tumor that is pressing on the nerve
  • Surgery to cut the trigeminal nerve
Other Treatments
Other options include:
  • Injections of alcohol or glycerin to deaden the nerve
  • High frequency radio waves to deaden the nerve

Prevention

There are no guidelines for preventing Trigeminal Neuralgia. However once you have it, steps that may prevent attacks include:
  • Eat soft foods.
  • Eat food and drink beverages that are room temperature.
  • Wash your face with cotton pads and warm water.
  • If tooth brushing triggers attacks, rinse your mouth with warm water after eating.
  • Avoid or minimize known triggers such as heat, cold, touch, or air.