Trigeminal Neuralgia
Trigeminal Neuralgia is a chronic pain condition that affects the trigeminal nerve, which is responsible for carrying sensations from the face to the brain. People with trigeminal neuralgia experience intense, sharp, or shock-like facial pain, typically on one side of the face. The condition is often described as one of the most excruciating pain disorders.
A disorder characterized by recurrent unilateral brief electric shock-like pains, abrupt in onset and termination, limited to the distribution of one or more divisions of the trigeminal nerve and triggered by innocuous stimuli. It may develop without apparent cause or be a result of another diagnosed disorder. Additionally, there may be concomitant continuous pain of moderate intensity within the distribution(s) of the affected nerve division(s).
Previously used terms:
Tic douloureux, primary trigeminal neuralgia.
Symptoms:
Pain in Specific Facial Areas: The pain usually occurs in the areas controlled by the trigeminal nerve, including the jaw, cheeks, lips, gums, forehead, or around the eyes.
Other Symptoms:
Triggered by Routine Actions: Simple activities such as brushing teeth, chewing, talking, or even touching the face may trigger an attack.
Short, Recurrent Pain Episodes: The pain is usually short-lived (a few seconds to two minutes) but can occur in rapid succession, often lasting for days, weeks, or months with periods of remission.
Asymmetric Pain: The condition typically affects only one side of the face.
Diagnostic criteria:
Recurrent paroxysms of unilateral facial pain in the distribution(s) of one or more divisions of the trigeminal nerve, with no radiation beyond1, and fulfilling criteria B and C
Pain has all of the following characteristics:
lasting from a fraction of a second to 2 minutes2
severe intensity3
electric shock-like, shooting, stabbing or sharp in quality
Precipitated by innocuous stimuli within the affected trigeminal distribution4
Not better accounted for by another ICHD-3 diagnosis.
Causes:
- Nerve Compression: The most common cause is the compression of the trigeminal nerve by nearby blood vessels, leading to nerve irritation. This pressure causes the nerve to misfire, sending exaggerated pain signals to the brain.
- Multiple Sclerosis (MS): In some cases, trigeminal neuralgia may be linked to MS, which damages the myelin sheath that protects nerves, including the trigeminal nerve.
- Nerve Damage or Injury: Trauma to the face, dental procedures, or surgeries that damage or irritate the trigeminal nerve can result in neuralgia.
- Aging: As people age, they are more likely to experience nerve compression or conditions like multiple sclerosis that contribute to trigeminal neuralgia.
- Tumors: Although rare, tumors pressing against the trigeminal nerve can also cause the condition.
- Other Causes: Infections such as shingles or nerve demyelination disorders may also contribute to trigeminal neuralgia.
In a few patients, pain may radiate to another division, but it remains within the trigeminal dermatomes.
Duration can change over time, with paroxysms becoming more prolonged. A minority of patients will report attacks predominantly lasting for >2 minutes. Pain may become more severe over time. Some attacks may be, or appear to be, spontaneous, but there must be a history or finding of pain provoked by innocuous stimuli to meet this criterion. Ideally, the examining clinician should attempt to confirm the history by replicating the triggering phenomenon. However, this may not always be possible because of the patient’s refusal, awkward anatomical location of the trigger and/or other factors
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