Understanding Trigeminal Neuralgia

Trigeminal neuralgia (TN), sometimes known as tic douloureux, has sometimes been described as some of the most excruciating pain that human beings can experience. The pain typically involves the middle and lower part of the face but can also affect the area around the nose and above the eye. The pain is described as an electric shock-like sensation as well as a sharp and stabbing pain lasting seconds to minutes. This pain is caused by irritation of the trigeminal nerve, which sends branches to the forehead, cheek, and lower jaw. The pain is usually limited to one side of the face. The nerve provides sensation to the face.
It most commonly affects people over the age of 50. It is more common in women than in men. Some doctors think the pain is caused by blood vessels pressing on the root of the trigeminal nerve, at the base of the brain. High blood pressure and multiple sclerosis are also risk factors. Other causes of TN include pressure due to a tumor on the nerve (this is almost always benign) or multiple sclerosis, which damages the covering of the nerve called myelin. Sometimes patients with migraine headaches have trigeminal nerve irritation.
Most patients report that their pain began spontaneously, while others may report that their pain followed a car accident, blow to the face, or dental procedures. It is not uncommon that I will see a patient after they have seen a dentist, endodontist, ENT physician, or oral surgeon. There are often periods of remission and the pain tends to run in cycles. Some patients suffer less than one attack a day, while others experience a dozen or more every hour. The following may trigger attacks of TN:
• Touching of the skin lightly
• Washing
• Shaving
• Blowing the nose
• Drinking hot or cold beverages
• Cold air
The diagnosis of TN is a clinical one – it is made by a thorough history and physical exam. An MRI and MRA of the head are necessary to rule out a tumor or multiple sclerosis, but often no precise cause can be found as to why the nerve is irritated. Medications to treat TN are very effective and are typically in the anti-seizure class such as oxcarbazepine, carbamazepine, gabapentin, pregabalin, among other medications. There are numerous pain procedures and even neurosurgical procedures that can help with the pain as well.
If you would like to learn how to care for this disease or any other neurological condition, please call (609) 653-9595 or (609) 463-8009. My office is conveniently located at 4 Village Drive in Cape May Court House and 160 Shore Road in Somers Point. Please visit my web site at www.stzorfas.com
-Submitted by Dr. Scott Stzorfas