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Trigeminal Neuralgia

Alternate Names

  • tic douloureux
  • Facial nerves

Definition

Neuralgia is a term for pain caused by an abnormality in a particular nerve, occurring for reasons that are often not fully understood.

What is going on in the body?

Nerve pain can affect almost any nerve in the body. Its cause is poorly understood. Some researchers have suggested that the pain results from an electrical problem in the nerve, much like a loose or damaged electrical wire. The fifth cranial nerve gives sensation to almost the entire face, explaining why the disorder can cause pain in different areas of the face. Fortunately, treatment can help stop the pain for most people.

Risks

What are the causes and risks of the condition?

This disorder is more common in women than men. It rarely affects people younger than 50 years old. In most cases, the exact cause is unknown.
In a minority of cases, a cause is found for this disorder. These causes include:
  • injury to the face or oral surgery
  • autoimmune disorders, in which the immune system attacks the person's own body. Autoimmune disorders include multiple sclerosis and scleroderma.
  • herpes zoster, often called shingles, which is a viral infection that can irritate nerves
  • abnormal arteries or blood vessels, which can compress the nerve. One example is an aneurysm, an abnormally widened area in an artery. Malformations of normal blood vessels, called arteriovenous malformations, are another cause.
  • benign or malignant tumors, which may also compress the nerve. In these cases, there are usually other symptoms in addition to nerve pain.

Prevention

What can be done to prevent the condition?

There is no known prevention for trigeminal neuralgia.

Diagnosed

How is the condition diagnosed?

There are no specific tests that can diagnose trigeminal neuralgia. The characteristic pain in this condition often allows a healthcare professional to make the diagnosis. Testing may be done to rule out other possible causes of facial pain, such as diseases of the jaw, teeth, or sinuses. For example, an x-ray of the sinuses may be done to rule out a sinus infection.

Long Term Effects

What are the long-term effects of the condition?

Without treatment, the person may have long-term pain and discomfort. The pain, and fear of the pain, can be so severe that some people cannot perform everyday tasks.
In the rare cases in which the cause is known, other long-term effects can result. For example, cancer can result in death. Multiple sclerosis can cause weakness, paralysis, and permanent disability in some cases.

Other Risks

What are the risks to others?

There are no risks to others.

Treatments

What are the treatments for the condition?

Treatment for this condition usually involves anti-seizure medications. These are thought to work by stabilizing the nerve. Carbamazepine (i.e., Tegretol) is usually tried first. If this medication does not work or it causes severe side effects, phenytoin (i.e., Dilantin), baclofen (i.e., Kemstro), clonazepam (i.e., Klonopin), or valproic acid (i.e., Depakene) can be tried.
If medication fails to control the pain, surgery may be needed. In the rare case of a known cause, treatment of the cause may stop the nerve pain. For example, surgery may be used to remove a tumor or abnormal blood vessels.

Side Effects

What are the side effects of the treatments?

Side effects of the medications may include nausea, loss of sleep, and headaches. Surgery can be complicated by infection, bleeding, an allergic reaction to the anesthetic, or numbness in the face if a nerve is cut intentionally.

After Treatment

What happens after treatment for the condition?

Medication usually makes the pain go away. If surgery is needed, it also usually stops the pain. In the rare case of a known cause, other monitoring or treatment may be needed..

Monitor

How is the condition monitored?

The person can monitor the pain at home, and report any new or worsening symptoms to the healthcare professional. The medications used often need monitoring. If a medication cannot control the pain, the dose may be changed.
If pain cannot be controlled with medications, surgery may be needed. In the rare case of a known cause, other monitoring may be needed, such as X-rays or other tests to check for progression of a tumor.

Sources

Mayo Clinic Family Health Book, 1996.

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