Trigeminal neuralgia (also called tic douloureux) is a chronic painful condition involving the fifth cranial nerve, called the trigeminal nerve. The trigeminal is the largest sensory cranial nerve. It is responsible for sensations of touch, pressure, pain, and temperature in your cheeks, jaw, gums, forehead, and eye areas. While this is not a life-threatening condition, it is so painful that some people actually become depressed and suicidal if they cannot get relief.
The symptoms of trigeminal neuralgia can be confused with migraine, toothache, and many other problems that cause facial pain, making it tricky to diagnose. Most commonly the pain is unilateral, sudden, recurrent, extreme, and burning or shock-like. It may last only seconds or a couple of minutes, but the pain is severe enough to be mentally and physically incapacitating.
Trigeminal neuralgia pain is provoked by everyday activities such as brushing your teeth, shaving, talking, drinking or even exposure to wind. Over time you may begin to avoid anything that might provoke the pain. People who suffer long term may avoid leaving the house altogether. As the condition progresses, attacks often become more severe and more frequent and the time between attacks shortens.
According to the National Institute of Neurological Disorders and Stroke, trigeminal neuralgia is presumed to be caused by a blood vessel pressing on the nerve. This can often be seen on MRI. It is important to look for the cause, because the treatment is dependent on the cause. It is most common in people over 50, more common in women than men, and approximately two to three percent of patients with trigeminal neuralgia have multiple sclerosis.
Treatment often begins with anticonvulsant medications that are thought to decrease nerve hyperactivity. People often require more than one medication to get relief. Sometimes this means more than one type of anticonvulsant, or the addition of a tricyclic antidepressant or even surgery. Typical pain medications such as narcotics or opioids do not usually relieve the pain of trigeminal neuralgia.