Trigeminal neuralgia (TN) is a disorder of the trigeminal nerve (fifth cranial nerve) that causes severe, shooting pain along one side of the face. It senses touch, pain, pressure, and temperature. It also helps make saliva and tears.
The Trigeminal Nerve
In TN, 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.
In most cases, the cause is unknown. Sometimes an abnormally formed artery or vein running too close to the nerve and compressing it proves to be the culprit. Rarely, TN may occur as a symptom of another underlying disorder, such as:
These factors increase your chance of developing TN. Tell your doctor if you have any of these risk factors:
- Age: 50 or older
- Sex: female (a slightly higher risk)
The main symptom is searing 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.
The pain is typically sudden, severe, and stabbing. Even though the pain is often brief (less than two minutes) it can reoccur hundreds of times per day. Attacks, which can become totally disabling, may seem to occur at random or be triggered by extremes of temperature, washing, shaving, touching, or tickling the face. There are usually no symptoms between attacks, except perhaps a dull ache.
The doctor will ask about your symptoms and medical history, and perform a physical exam.
Tests may be performed to help diagnosis underlying conditions that may lead to TN. These 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 the antiseizure medication (eg, ]]>carbamazepine]]> ). This medicine may reduce pain and is sometimes used to help diagnose the disorder.
Treatment usually begins with medication. If medication fails, other options are available.
Medications may include:
- Other antiseizure medications (eg, phenytoin]]> , ]]>gabapentin]]> , ]]>lamotrigine]]> , ]]>oxcarbazepine]]> , ]]>pregabalin]]> , ]]>topiramate]]> )
- Low-dose antidepressants (eg, ]]>amitriptyline]]> , ]]>clomipramine]]> )
- Muscle relaxer (eg, ]]>baclofen]]> )
- Other medications, such as ]]>sumatriptan]]> (Imitrex) injection, lidocaine nasal spray ]]>*¹]]>
Surgical options include:
- Surgery to remove an artery or tumor that is pressing on the nerve
- Surgery to cut the trigeminal nerve
Surgery can be highly effective in some cases. The most common procedure is microvascular decompression.
Other options to deaden the trigeminal nerve include:
- ]]>Stereotactic radiosurgery]]> (also known as Gamma Knife, CyberKnife, LINAC, and other names)
- Injections of alcohol or glycerin to deaden the nerve
- High-frequency radio waves to deaden the nerve
These procedures may be somewhat less effective than microvascular surgical decompression. But, they are widely used, especially in older patients.
There are no guidelines for preventing TN. However, once you have it, steps that may help prevent attacks include:
- Eating soft foods
- Eating food and drinking beverages that are room temperature
- Washing your face with cotton pads and warm water
- If tooth brushing triggers attacks, rinsing your mouth with warm water after eating
- Avoiding or minimizing known triggers (eg, heat, cold, touch)
American Chronic Pain Association
Trigeminal Neuralgia Association
Your Complete Guide to Trigeminal Neuralgia
University of Manitoba
Chole R, Pati R, Degwekar SS, Bhowate RR. Drug treatment of trigeminal neuralgia: a systematic review of the literature. J Oral Maxillfac Surg . 2007; 65:40-45.
Current Medical Diagnosis and Treatment . 44th ed. 2005.
Gorgulho AA, DeSalles AAF. Trigeminal neuralgia: impact of radiosurgery on the surgical treatment of trigeminal neuralgia. Surgical Neurology . 2006; 66:350-356.
Kalkanis SN, Eskandar EN, Carter BS, Barker FG II. Microvascular decompression surgery in the United States, 1996-2000: mortality rates, morbidity rates, and the effects of hospital and surgeon volumes. Neurosurgery . 2003;52:1251-1261.
NINDS trigeminal neuralgia information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/ . Updated February 2009. Accessed February 13, 2009.
Pollock BE, Ecker RD. A prospective cost-effectiveness study of trigeminal neuralgia surgery. Clin J Pain . 2005;21:317-22.
Viel M. Pregabalin for the treatment of trigeminal neuralgia. Am Fam Physician. 2008;78:808.
*¹11/29/2006 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Kanai A, Saito M, Hoka S. Subcutaneous sumatriptan for refractory trigeminal neuralgia. Headache . 2006;46:577-82.
Last reviewed January 2009 by ]]>Rimas Lukas, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © 2007 EBSCO Publishing All rights reserved.