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Trigeminal neuralgia

Trigeminal neuralgia is a nerve disorder that causes a stabbing or electric-shock-like pain in parts of the face.

Alternative Names

Tic douloureux

Causes

The pain of trigeminal neuralgia comes from the trigeminal nerve. This nerve carries the feelings of touch and pain from the face, eyes, sinuses, and mouth to the brain.

The condition usually affects adults, but it can affect anyone at any age.

Trigeminal neuralgia may be caused by:

  • Multiple sclerosis
  • Pressure on the trigeminal nerve from a swollen blood vessel or tumor

Often, no cause is found.

Doctors are more likely to find a cause in a person who is younger than age 40.

Symptoms

Symptoms may include any of the following:

  • Very painful, sharp electric-like spasms that usually last a few seconds or minutes, but can become constant
  • Pain is usually only on one side of the face, often around the eye, cheek, and lower part of the face
  • Pain may be triggered by touch or sounds

Painful attacks of trigeminal neuralgia can be triggered by common, everyday activities, such as brushing teeth, chewing, drinking, eating, touching the face, or shaving.

Exams and Tests

A brain and nervous system (neurologic) examination is usually normal.

Tests that are done to look for the cause may include:

Treatment

Your primary care physician, a neurologist, or a pain specialist may be involved in your care.

Certain medicines sometimes help reduce pain and the rate of attacks. These medicines include:

  • Anti-seizure drugs
  • Muscle relaxants
  • Tricyclic antidepressants

Some patients may need surgery to relieve pressure on the nerve. Techniques include:

  • Cutting or destroying part of the trigeminal nerve
  • Destroying the trigeminal nerve with a needle or probe placed through the skin using radiofrequency ablation or an injection of glycerol
  • Electrostimulation
  • Percutaneous balloon microcompression
  • Removal of the tumor (when a tumor is the cause)
  • Stereotactic radiosurgery (Gamma knife)
  • Surgery to remove a blood vessel that is putting pressure on the trigeminal nerve (called microvascular decompression, or MVD)

Outlook (Prognosis)

How well you do depends on the cause of the problem. If there is no disease causing the problem, treatment can provide some relief.

In some persons, the pain becomes constant and severe.

References

Gronseth G, Cruccu G, Alksne J, Argoff C, Brainin M, Burchiel K, et al. Practice parameter: the diagnostic evaluation and treatment of trigeminal neuralgia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the European Federation of Neurological Societies. Neurology. 2008;71:1183-1190.

Singla A. Trigeminal neuralgia. In: Frontera WR, Silver JK, Rizzo TD, eds. Essentials of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2008:chap 90.

Zhou Y. Principles of pain management. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 44.

Updated: 5/20/2014

Joseph V. Campellone, M.D., Division of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.


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