Trigeminal neuralgia (TN or tic douloureux) is a disorder of the fifth cranial (trigeminal) nerve that causes episodes of intense, stabbing, electric shock-like pain in the areas of the face where the branches of the nerve are distributed – lips, eyes, nose, scalp, forehead, upper jaw, and lower jaw.
The attacks of pain, generally last several seconds but may be repeated one after the other, throughout the day. The attacks may come and go and last for days, weeks, or months at a time, and then disappear for days, months or years.
TN is present in 100 to 200 people per 100 000, and new TN cases occur in 5 people per 100 000 each year.
- Pain is described as lancinating – (sharp)
- Pain comes and goes (intermittent)
- Pain must be in the distribution of the trigeminal nerve.
- There is remission.
- A diagnostic tool is the response to Tegretol ( Carbamazepine); or other antiepileptic medications.
- The pain is triggered.
Pain triggers may include:
- touch – rubbing the face, brushing your teeth, blowing your nose or shaving
- facial movement – chewing, talking, smiling
- temperature – drinking hot or cold liquids, cold breezes, washing with cold water
Facial Pain Classifications
Oregon Health & Science University’s (OHSU) Dr. Kim Burchiel has provided a questionnaire to help you diagnosis your facial pain. To complete the series of 22 yes/no questions, please visit:
The classifications are:
- Trigeminal neuralgia, type 1, (TN1): facial pain of spontaneous onset with greater than 50% limited to the duration of an episode of pain (temporary pain).
- Trigeminal neuralgia, type 2, (TN2): facial pain of spontaneous onset with greater than 50% as a constant pain.
- Trigeminal neuropathic pain, (TNP): facial pain resulting from unintentional injury to the trigeminal system from facial trauma, oral surgery, ear, nose and throat (ENT) surgery, root injury from posterior fossa or skull base surgery, stroke, etc.
- Trigeminal deafferentation pain, (TDP): facial pain in a region of trigeminal numbness resulting from intentional injury to the trigeminal system from neurectomy, gangliolysis, rhizotomy, nucleotomy, tractotomy, or other denervating procedures.
- Symptomatic trigeminal neuralgia, (STN): pain resulting from multiple sclerosis.
- Postherpetic neuralgia, (PHN): pain resulting from trigeminal Herpes zoster outbreak.
- Atypical facial pain, (AFP): pain predominantly having a psychological rather than a physiological origin.
Surgical procedures would not help TNP, TDP, STN, PHN, and AFP.
Other Cranial Neuralgias
- Glossopharyngeal Neuralgia.
- Nervus Intermedius (or Geniculate Neuralgia).
- Vegal and Superior Laryngeal Neuralgia.
- Occipital Neuralgia
Related Facial Disorders
- Postherpetic Neuralgia
- Hemifacial Spasm (HFS)
- Acoustic Neuroma
- Parry-Romberg Syndrome
- Multiple Sclerosis
- Pre – Trigeminal Neuralgia.
- Tic convulsif
- Maxillary sinusitis
- Giant cell arteritis
What is the trigeminal nerve?
The trigeminal nerve consists of 3 nerve branches:
- Ophthalmic – eye, forehead and nose.
- Maxillary upper teeth, gums and lip, the cheek, lower eyelid and the side of the nose.
- Mandibular – lower teeth, gums and lip.
The nerve transmits pressure, touch, pain and temperature signals to the brain and controls jaw movement.
TN pain can involve one or more branches of the trigeminal nerve.
The three divisions of the trigeminal nerve come together in an area called the gasserion ganglion. From there, the trigeminal nerve root continues back towards the side of the brain stem, and inserts into the pons. Within the brain stem, the signals travelling through the trigeminal nerve reach specialised clusters of neurons called the trigeminal nerve nucleus. Information brought to the brain stem by the trigeminal nerve is then processed before being sent to the cerebral cortex, where a conscious perception of facial sensation is generated.
Follow the links below for more information about trigeminal neuralgia.
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