Trigeminal Neuralgia

What Is Trigeminal Neuralgia?

Also known as tic douloureux (painful tic), trigeminal neuralgia (TN) is a chronic, lifelong condition that causes agonizing pain. The painful episodes usually focalize on one side of the face, develop in a matter of seconds, and can disrupt your daily life.

The pain stems from a problem with the trigeminal nerve, which is a set of cranial nerves starting from the top of the ear and splitting off across the side of the face. Although you have two trigeminal nerves – one for each side of the face – TN usually affects only one of these nerves.

In people with TN, the dysfunction of the trigeminal nerve often occurs due to a blood vessel pressing on and damaging the nerve. However, this condition may also have other causes, such as tumors, surgical injuries, facial trauma, or multiple sclerosis.

The pain deriving from this disease is often described as an electric shock-like, stabbing sensation, so intense that it can prevent you from drinking, eating, smiling, or speaking.

The Prevalence, Incidence, and Impact of Trigeminal Neuralgia

Trigeminal neuralgia is considered a rare disorder, affecting around 5.5 people per 100,000. Only around 15,000 new cases of TN are registered annually in the US, and women – especially those aged 50 and over – are twice as likely as men to experience it.

Despite its rarity, this condition can be extremely severe. The painful episodes it causes are unpredictable and agonizing, leading to significant mental and physical distress. Currently, there is no definitive cure for TN. Surgical interventions may help suppress symptoms temporarily, while pharmaceuticals can help manage pain.

Because of the lack of a cure and the intense pain, trigeminal neuralgia can significantly impact mental health. In a 2018 study, TN accounted for 26% of all attempted suicides in people with chronic headache disorders.

Fortunately, today’s patients have hope for an effective treatment option that does not involve pharmaceuticals or surgery.

Anatomy And Physiology Of The Trigeminal Nerve

Trigeminal neuralgia results from disruptions in the function of the trigeminal nerve. This can occur when a blood vessel comes into contact with and compresses the nerve, although other conditions can also cause trigeminal nerve damage.

To understand how TN relates to trigeminal nerve damage, let’s explore the function and anatomy of this nerve.

The Function Of The Trigeminal Nerve

The trigeminal nerve is one of the 12 pairs of cranial nerves stemming from the brain and spreading throughout the body. These nerves are responsible for transmitting signals to the brain related to sensations, pain, touch, vibration, muscle movements, and bodily functions such as heartbeat and digestion. These signals are processed by the brain, enabling you to move your muscles and experience sensations in response to stimuli.

The trigeminal nerve, in particular, branches out into the face and is responsible for transmitting pain, touch, and temperature sensations from your face to the brain.

Trigeminal Nerve Branches

There are two trigeminal nerves, one located on each side of the face. Each nerve starts near the top of the ear and then splits into three branches:

• The Ophthalmic Branch: This is the upper branch of the trigeminal nerve. It spreads across the scalp and forehead, transmitting signals to the brain relating to the upper portion of your head.
• The Maxillary Branch: This branch connects the middle portion of your face to the brain, including the cheek, upper jaw, nostrils, and upper lip.
• The Mandibular Branch: The lower branch supplies nerve endings in the lower jaw area, bottom lip, teeth, and gums.

Role In Facial Sensation

The trigeminal nerve transmits sensations from various parts of the face to the brain. This connection can be disrupted due to nerve damage, which may occur if the trigeminal nerve is compressed, irritated, or inflamed.

When this nerve is damaged, it can misfire, causing sudden electric shock-like sensations. Pain may also be triggered by normally painless stimuli, such as brushing your hair, touching your face, or putting on makeup.

Although it may feel like the pain affects the entire side of your face, it typically centers around the area where one of the nerve branches is irritated or damaged. The intensity of trigeminal neuralgia pain is often reported to be more severe than a heart attack or childbirth.

Types of Trigeminal Neuralgia

Trigeminal neuralgia consistently causes excruciating pain, but the intensity, pattern, frequency, and location of flare-ups can vary among individuals.

In most cases, painful sensations occur in intermittent bouts, characterized by stabbing sensations. Some people may also experience constant aching or burning pain.

Depending on your symptoms, your condition may be classified as classic trigeminal neuralgia or atypical trigeminal neuralgia. Let’s explore these variations below.

Type 1: Classic Trigeminal Neuralgia

Also known as “classic,” Type 1 trigeminal neuralgia is the most common form. If you have this condition, you’ll experience episodes of sharp and burning sensations on one side of your face.

These episodes start with mild numbness and tingling and reach full intensity within seconds. Each burst of pain can last from a few seconds to two minutes before subsiding.

The bouts of pain usually occur in close succession and are followed by brief pain-free periods. They can continue intermittently for up to two hours, with some people experiencing hundreds of attacks a day. After a flare-up, you may enjoy a period of remission without pain for months or years. However, the remission periods tend to shorten over time, and the pain inevitably returns.

A flare-up of trigeminal neuralgia can be triggered by contact with the cheek, vibration, or touch, such as when washing your face, eating, or drinking. Attacks rarely occur during sleep.

Type 2: Atypical Trigeminal Neuralgia

Atypical, or Type 2, trigeminal neuralgia is less common than classic TN. This form causes painful sensations that may be less intense but more widespread and constant. People with atypical TN often describe their pain as stabbing, burning, aching, or dull, and they generally have more difficulty managing their symptoms.

While Type 2 TN pain may not be as excruciating as Type 1, it can be equally life-limiting, especially as attacks progress and worsen over time. Additionally, the periods of remission become fewer and shorter, and medications become less effective in controlling the pain.

Complicating the clinical picture of Type 2 trigeminal neuralgia is the overlap of symptoms with other conditions, such as temporomandibular joint (TMJ) disorders, craniocervical instability (CCI), and transverse cervical nerve (TCN) disorders. This often leads to misdiagnosis and inadequate treatment.

Characteristics Of Trigeminal Neuralgia Pain

Trigeminal neuralgia pain can vary among individuals, but there are common patterns. The pain is known to be one of the most excruciating sensations, often described as worse than childbirth or a heart attack.

Additionally, the attacks typically follow a similar pattern:

• During an attack, shock-like sensations occur in rapid succession, each lasting between a few seconds and two minutes.
• Intermittent bouts of pain can last for two hours or longer. As the damage to the trigeminal nerve progresses, attacks tend to last longer and become more intense.
• Periods of remission can last from a few weeks to several years. However, trigeminal neuralgia never disappears on its own, and the pain-free periods tend to shorten over time.
• Trigeminal neuralgia pain typically affects one side of the face. In nearly 60% of cases, the right side of the face is affected. Bilateral neuralgia is very rare.

Working with a specialist can help you better understand the patterns and characteristics of trigeminal neuralgia pain.

Factors Contributing to Facial Nerve Pain

Although anyone can experience trigeminal neuralgia, certain factors may increase your risk:

• Age: The aging process can lead to a decline in the health and function of the nervous system, making trigeminal neuralgia and nerve damage more likely. This condition mostly develops in adults between 37 and 67 years old.
• Gender: Women are twice as likely as men to suffer from TN.
• Excessive Dental Procedures: Invasive or improper dental procedures can damage the trigeminal nerve.
• Cardiovascular Disease: If you have high blood pressure or have suffered a stroke, the trigeminal nerve is more likely to be compressed by a blood vessel or damaged.
• Playing Contact Sports: Engaging in activities that increase the chances of facial trauma can increase your risk of developing trigeminal neuralgia later in life.

Evaluating Facial Nerve Disorders

Although there is no definitive diagnostic procedure for trigeminal neuralgia, a neurologist or healthcare specialist can determine the cause of your facial pain. However, because symptoms often overlap with other conditions, atypical TN is more challenging to identify and can sometimes be misdiagnosed.

Diagnosing trigeminal neuralgia involves the following steps:

• Medical History and Physical Examination: Your doctor will review the nature and pattern of your symptoms, assess your medical history, and perform a physical examination of your face to rule out other underlying conditions.
• Neurological Examination: During a neurological exam, a specialist will evaluate your mental health, muscle strength, and reflexes. They will also check for nerve abnormalities by testing facial sensations, checking your hearing and vision, and observing the movement of your eyes, mouth, neck, and shoulders.
• Imaging Studies: Computerized tomography (CT) and high-resolution magnetic resonance imaging (MRI) scans provide a clear picture of the anatomy of the trigeminal nerve. These scans can identify abnormalities such as a tumor or blood vessels that may be compressing the nerve. These tests can also diagnose underlying conditions causing trigeminal neuralgia pain, such as multiple sclerosis.
• Electrophysiological Tests: These tests are used to evaluate the health of your body’s electrical system.

Managing Trigeminal Neuralgia With NextPain Care

At NextPain Care, we are dedicated to helping you manage the debilitating pain of trigeminal neuralgia with a comprehensive, patient-focused approach. Our expert team uses the latest advancements in medical treatments and personalized care plans to meet your unique needs.

Don’t let trigeminal neuralgia control your life any longer. Trust NextPain Care to be your partner in this journey, offering compassionate care and effective solutions. Take the first step towards reclaiming your comfort and well-being—reach out to us today and learn how our treatments can help improve your quality of life.