Trigeminal neuralgia (TN), formerly called tic douloreux, is the most common facial pain syndrome and is often described as "the most terrible pain known to man". It is characterized by sudden (paroxysmal) attacks of facial pain described as intense, sharp, electric-shock like, or stabbing. The pain is most commonly felt in the cheekbone, nose, upper lip and upper teeth. In some people, the pain also extends to the lower lip, teeth, and chin. Pain is usually felt on one side of the face (unilateral) and lasts from a few seconds to two minutes. People with TN report that the intermittent pain attacks and the anticipatory anxiety of not knowing when they will occur result in a significant deterioration of quality of life and interfere with daily activities such as eating and sleeping. Typically, TN is caused by compression of the trigeminal nerve by a blood vessel near the brainstem. In many cases, however, a specific cause cannot be identified. This is referred to as idiopathic trigeminal neuralgia.

The International Association for the Study of Pain (IASP) classifies TN into the following 3 types based on the underlying causes of the condition:

• Idiopathic TN - no apparent cause can be identified.

• Classic TN - caused by a blood vessel compressing the trigeminal nerve root.

• Secondary TN - most frequently caused by multiple sclerosis or a benign tumor at the cerebellopontine angle, which is an area located between the cerebellum and the pons (a part of the brainstem).

Various studies have estimated the incidence of TN to range from 4 to 27 cases per 100,000 per year. The condition affects women more often than men. In one large study published in 2016, the proportion of women to men with TN was about 3 to 1.TN is most commonly observed in people between the ages of 37 to 67 years. The average age of onset of classic TN is 53, while patients with secondary TN tend to be about 10 years younger with an average age of onset of 43 years.

Many patients describe a specific triggering event that may precipitate an attack of classic TN. These triggers can include chewing, talking, swallowing, tooth brushing, and shaving.

The diagnosis of trigeminal neuralgia is a clinical one based on the history of an individual's signs and symptoms. Once the diagnosis has been established clinically, magnetic resonance imaging (MRI) is often used to determine if the pain is caused by compression of the trigeminal nerve root by a blood vessel.

The hallmark feature of trigeminal neuralgia is orofacial pain which the IASP defines as "sudden, unilateral, severe, brief, stabbing, recurring episodes of pain in the distribution of one or more branches of the trigeminal nerve".

Orofacial pain may occur as a result of several other medical conditions. These conditions must be excluded before a doctor reaches a definitive diagnosis of trigeminal neuralgia. Other possible causes of facial pain that must be taken into consideration include ear infections, sinusitis, acute glaucoma, "phantom" tooth pain, and post-herpetic neuralgia.

The two primary goals of treatment for trigeminal neuralgia are:

• Controlling the symptoms
• Treating an identified underlying cause of TN

In general, the following treatment options are available for patients with trigeminal neuralgia:

• Drug therapy
• Surgical therapy
• Sterotactic Radiosurgery
• Percutaneous procedures
• Nerve blocks

Trigeminal neuralgia is not a life-threatening illness. Some patients experience a remission of pain lasting many years, while for others the symptoms intensify. Patients should monitor symptoms and discuss them with a physician so that appropriate steps to manage pain can be taken.

Many patients with trigeminal neuralgia experience recurrences of intense painful episodes. Initially most patients will respond to drug therapy, but over time medications become less effective and patients may begin to experience more frequent painful attacks as well as shorter periods of pain relief between episodes. When the pain becomes intractable or interferes significantly with daily activities, patients should be offered other available treatment options.

Knowledge is Critical when Dealing with a Life-Altering Condition such as Trigeminal Neuralgia

If you or a loved one has been diagnosed with trigeminal neuralgia, it's critical to learn everything you possibly can about this condition so that you can make informed decisions about your treatment. That's why we created the Medifocus Guidebook on Trigeminal Neuralgia, a comprehensive 131 page patient Guidebook that contains vital information about trigeminal neuralgia that you won't find anywhere in a single source.

The Medifocus Guidebook on Trigeminal Neuralgia starts out with a detailed overview of the condition and quickly imparts fundamentally important information about trigeminal neuralgia, including:

• The underlying causes of trigeminal neuralgia.
• The risk factors that can increase a person's chances for developing trigeminal neuralgia.
• The triggers that can precipitate an acute attack of trigeminal neuralgia in many patients.

• An overview of the International Headache Society's classification system that groups patients with trigeminal neuralgia into the following two major categories:

  • Classical (idiopathic) trigeminal neuralgia
  • Symptomatic trigeminal neuralgia

• The signs and symptoms associated with trigeminal neuralgia.

• A list of other underlying conditions that can cause severe facial pain and may be confused with trigeminal neuralgia that must be taken into consideration in the differential diagnosis of trigeminal neuralgia.
• How trigeminal neuralgia is diagnosed based on factors such as signs/symptoms, patient history, physical examination, dental examination, and imaging studies.

Understanding the Standard Treatments... and the Treatment Options

The primary goals of treatment for patients with trigeminal neuralgia include:

• Controlling the symptoms.
• Relieving severe facial pain.
• Treating the underlying cause of trigeminal neuralgia in cases where an underlying cause has been identified.
• Enabling the patient to function and lead a reasonably good quality of life.

Understanding the standard treatments - and the treatment options - is critical for successfully achieving the goals of treatment for trigeminal neuralgia. As you read through the section of the Guidebook that focuses on the treatments for trigeminal neuralgia, you will specifically learn about:

• The major types of medications that are commonly prescribed to relieve pain in patients with trigeminal neuralgia including anticonvulsants, antidepressants, and muscle relaxants.
• The common side-effects of specific medications that are used for pain relief.
• The role of nerve blocks with drugs such as local anesthetics or ethanol in the management of trigeminal neuralgia.

• The surgical treatment options that are available for patients with intractable trigeminal neuralgia that cannot be adequately controlled with medications, which include:

  • Microvascular decompression surgery
  • Percutaneous rhizotomy (gangliolysis)

• The risks, benefits, and complications associated with the various surgical approaches for the treatment of trigeminal neuralgia.

• A detailed discussion of a novel, non-surgical treatment option called stereotactic radiosurgery (Gamma Knife) that has recently become available and has been shown to be effective for the treatment of trigeminal neuralgia in many patients.

• A detailed overview of the American Academy of Neurology's practice guidelines published in 2008 regarding the management of patients with trigeminal neuralgia, including:

  • Diagnostic criteria for trigeminal neuralgia
  • Drug therapy for pain relief
  • Surgical therapy

• The role of complementary and alternative therapies in the management of trigeminal neuralgia.

• Quality of life issues that often confront people who suffer with trigeminal neuralgia including tips and suggestions for how to minimize their impact and better cope with the condition.
• Important questions to ask your doctor about trigeminal neuralgia.

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Updated: January 26, 2023
131 Pages