About trigeminal neuralgia (tic douloureux)

What is trigeminal neuralgia (tic douloureux)?

Trigeminal neuralgia, also known as tic douloureux, is a disorder of the fifth cranial nerve (trigeminal nerve) characterized by attacks of intense, stabbing pain affecting the mouth, cheek, nose, and/or other areas on one side of the face. The exact cause of trigeminal neuralgia is not fully understood.



What are the symptoms for trigeminal neuralgia (tic douloureux)?

Burning sensation to one side of the face symptom was found in the trigeminal neuralgia (tic douloureux) condition

Trigeminal neuralgia results in Pain occurring in an area of the face supplied by one or more of the three branches of the trigeminal nerve.

Trigeminal neuralgia symptoms may include one or more of these patterns:

  • Episodes of severe, shooting or jabbing Pain that may feel like an electric shock
  • Spontaneous attacks of Pain or attacks triggered by things such as touching the face, chewing, speaking or brushing teeth
  • Attacks of Pain lasting from a few seconds to several minutes
  • Pain that occurs with facial spasms
  • Bouts of multiple attacks lasting days, weeks, months or longer — some people have periods when they experience no pain
  • Pain in areas supplied by the trigeminal nerve, including the cheek, jaw, teeth, gums, lips, or less often the eye and forehead
  • Pain affecting one side of the face at a time
  • Pain focused in one spot or spread in a wider pattern
  • Pain rarely occurring at night while sleeping
  • Attacks that become more frequent and intense over time



What are the causes for trigeminal neuralgia (tic douloureux)?

Trigeminal neuralgia 

Trigeminal neuralgia is caused by a disruption in the trigeminal nerve's function.

In trigeminal neuralgia, also called tic douloureux, the trigeminal nerve's function is disrupted. Usually, the problem is contact between a normal blood vessel — in this case, an artery or a vein — and the trigeminal nerve at the base of your brain. This contact puts pressure on the nerve and causes it to malfunction.

While compression by a blood vessel is one of the more common causes of trigeminal neuralgia, there are many other potential causes as well. Some may be related to multiple sclerosis or a similar disorder that damages the myelin sheath protecting certain nerves. Trigeminal neuralgia can also be caused by a tumor compressing the trigeminal nerve.

Some people may experience trigeminal neuralgia due to a brain lesion or other abnormalities. In other cases, surgical injuries, stroke or facial trauma may be responsible for trigeminal neuralgia.

Triggers

A variety of triggers may set off the pain of trigeminal neuralgia, including:

  • Shaving
  • Touching your face
  • Eating
  • Drinking
  • Brushing your teeth
  • Talking
  • Putting on makeup
  • Breeze lightly blowing over your face
  • Smiling
  • Washing your face



What are the treatments for trigeminal neuralgia (tic douloureux)?

Trigeminal neuralgia treatment usually starts with medications, and some people don't need any additional treatment. However, over time, some people with the condition may stop responding to medications, or they may experience unpleasant side effects. For those people, injections or surgery provide other trigeminal neuralgia treatment options.

If your condition is due to another cause, such as multiple sclerosis, your doctor will treat the underlying condition.

Medications

To treat trigeminal neuralgia, your doctor usually will prescribe medications to lessen or block the pain signals sent to your brain.

  • Anticonvulsants. Doctors usually prescribe carbamazepine (Tegretol, Carbatrol, others) for trigeminal neuralgia, and it's been shown to be effective in treating the condition. Other anticonvulsant drugs that may be used to treat trigeminal neuralgia include oxcarbazepine (Trileptal, Oxtellar XR), lamotrigine (Lamictal), valproate and phenytoin (Dilantin, Phenytek, Cerebyx). Other drugs, including clonazepam (Klonopin), topiramate (Qsymia, Topamax, others), pregabalin (Lyrica) and gabapentin (Neurontin, Gralise, Horizant), also may be used.

    If the anticonvulsant you're using begins to lose effectiveness, your doctor may increase the dose or switch to another type. Side effects of anticonvulsants may include dizziness, confusion, drowsiness and nausea. Also, carbamazepine can trigger a serious drug reaction in some people, mainly those of Asian descent, so genetic testing may be recommended before you start carbamazepine.

  • Antispasmodic agents. Muscle-relaxing agents such as baclofen (Gablofen, Lioresal, Ozobax) may be used alone or in combination with carbamazepine. Side effects may include confusion, nausea and drowsiness.
  • Botox injections. Small studies have shown that onabotulinumtoxinA (Botox) injections may reduce pain from trigeminal neuralgia in people who are no longer helped by medications. However, more research needs to be done before this treatment is widely used for this condition.

Surgery

Surgical options for trigeminal neuralgia include:

  • Microvascular decompression. This procedure involves relocating or removing blood vessels that are in contact with the trigeminal root to stop the nerve from malfunctioning. During microvascular decompression, your doctor makes an incision behind the ear on the side of your pain. Then, through a small hole in your skull, your surgeon moves any arteries that are in contact with the trigeminal nerve away from the nerve, and places a soft cushion between the nerve and the arteries.

    If a vein is compressing the nerve, your surgeon may remove it. Doctors may also cut part of the trigeminal nerve (neurectomy) during this procedure if arteries aren't pressing on the nerve.

    Microvascular decompression can successfully eliminate or reduce pain for many years, but pain can recur by 10 years in three out of 10 people. Microvascular decompression has some risks, including decreased hearing, facial weakness, facial numbness, a stroke or other complications. Most people who have this procedure have no facial numbness afterward.

  • Brain stereotactic radiosurgery (Gamma knife). In this procedure, a surgeon directs a focused dose of radiation to the root of your trigeminal nerve. This procedure uses radiation to damage the trigeminal nerve and reduce or eliminate pain. Relief occurs gradually and may take up to a month.

    Brain stereotactic radiosurgery is successful in eliminating pain for the majority of people. However, like all procedures, there is a risk of recurrence, often within 3 to 5 years. If pain recurs, the procedure can be repeated or an alternative procedure can be performed. Facial numbness is a common side effect, and may occur months or years after the procedure.

Other procedures may be used to treat trigeminal neuralgia, such as a rhizotomy. In a rhizotomy, your surgeon destroys nerve fibers to reduce pain, and this causes some facial numbness. Types of rhizotomy include:

  • Glycerol injection. During this procedure, your doctor inserts a needle through your face and into an opening in the base of your skull. Your doctor guides the needle into the trigeminal cistern, a small sac of spinal fluid that surrounds the trigeminal nerve ganglion — where the trigeminal nerve divides into three branches — and part of its root. Then, your doctor will inject a small amount of sterile glycerol, which damages the trigeminal nerve and blocks pain signals.

    This procedure often relieves pain. However, some people have a later recurrence of pain, and many experience facial numbness or tingling.

  • Balloon compression. In balloon compression, your doctor inserts a hollow needle through your face and guides it to a part of your trigeminal nerve that goes through the base of your skull. Then, your doctor threads a thin, flexible tube (catheter) with a balloon on the end through the needle. Your doctor inflates the balloon with enough pressure to damage the trigeminal nerve and block pain signals.

    Balloon compression successfully controls pain in most people, at least for a period of time. Most people undergoing this procedure experience at least some temporary facial numbness.

  • Radiofrequency thermal lesioning. This procedure selectively destroys nerve fibers associated with pain. While you're sedated, your surgeon inserts a hollow needle through your face and guides it to a part of the trigeminal nerve that goes through an opening at the base of your skull.

    Once the needle is positioned, your surgeon will briefly wake you from sedation. Your surgeon inserts an electrode through the needle and sends a mild electrical current through the tip of the electrode. You'll be asked to indicate when and where you feel tingling.

    When your neurosurgeon locates the part of the nerve involved in your pain, you're returned to sedation. Then the electrode is heated until it damages the nerve fibers, creating an area of injury (lesion). If your pain isn't eliminated, your doctor may create additional lesions.

    Radiofrequency thermal lesioning usually results in some temporary facial numbness after the procedure. Pain may return after three to four years.



What are the risk factors for trigeminal neuralgia (tic douloureux)?

Trigeminal neuralgia (tic douloureux) is a disorder that causes one side of the face to experience pain that feels like an electric shock. The trigeminal nerve, which transmits feeling from your face to your brain, is impacted by this chronic pain syndrome. If you have trigeminal neuralgia, even slight facial stimulation, such as when you clean your teeth or put on cosmetics, can send a sharp, terrible pain through your face.

At first, you can encounter brief, mild attacks. However, trigeminal neuralgia can advance and result in longer, more frequent episodes of excruciating pain. Women experience trigeminal neuralgia more frequently than males do, and persons older than 50 are more prone to develop it.

Risk factors for trigeminal neuralgia (tic douloureux)

1. Trigeminal neuralgia (tic douloureux) is more prevalent in elderly adults (often 50 and older), in women than in males, and more frequently affects the right side of the face than the left. Typically, it does not run in families.

2. Trigeminal neuralgia (tic douloureux) often develops on its own, however, it can occasionally be brought on by facial trauma or dental treatments.

3. Vascular compression, another name for the condition where a blood vessel presses against the trigeminal nerve, maybe the cause. The insulation, known as myelin, can be worn away over time by the pressure of an artery pressing on the nerve, leaving the nerve exposed and extremely sensitive.

4. The ensuing symptoms may resemble those brought on by dental issues. Thus, individuals with untreated trigeminal neuralgia occasionally experiment with various dental procedures in an effort to manage the pain.

Symptoms
Numbness and/or a tingling sensation,Short bursts of severe pain,Regular aches and pains,Burning sensation to one side of the face
Conditions
Loss of hearing,Facial weakness and numbness,Stroke or death,Double vision
Drugs
Carbamazepine (Tegretol, Carbatrol, others)



Is there a cure/medications for trigeminal neuralgia (tic douloureux)?

Treatment options for trigeminal neuralgia (tic douloureux) symptoms include medication, surgery, and complementary therapy.

Medications

1. Medications that prevent seizures. Usually, the first drug of choice for treating trigeminal neuralgia pain is carbamazepine.
2. Other anticonvulsant medications that your doctor might recommend include oxcarbazepine, phenytoin, lamotrigine, sodium valproate, gabapentin, clonazepam, and topiramate.
3. If you've been taking one of these drugs and don't think it's working as well as it should, you can ask your doctor to up the dosage or switch to a different kind of drug. These anticonvulsant medications have certain side effects, such as sleepiness, nausea, dizziness, and confusion, but they can also aid with pain relief.

Surgery

1. You might be suitable for surgery if none of these treatments works for you or you think your illness is getting worse over time.
2. There are numerous surgical procedures available to you.
3. Based on the degree of your discomfort, your preferences, your physical health, any prior surgeries, the relative risks and advantages of the procedure, and other factors, your doctor will probably suggest one to you.
4. Surgery is also more challenging for patients with Type 2 trigeminal neuralgia.

Symptoms
Numbness and/or a tingling sensation,Short bursts of severe pain,Regular aches and pains,Burning sensation to one side of the face
Conditions
Loss of hearing,Facial weakness and numbness,Stroke or death,Double vision
Drugs
Carbamazepine (Tegretol, Carbatrol, others)



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