Types of Trigeminal Neuralgia

Trigeminal neuralgia (TN), also known as tic douloureux, is a rare neurological disorder that affects the trigeminal nerve. While there is no cure for the disorder, there are treatment options ranging from prescription medication to surgery.

Types

1. The trigeminal nerve runs on either side of the face, radiating outward from the side and fanning out from the forehead down to the jaw. To get an idea of what this looks like, place the heel of your hand at your ear and spread your fingers out. Trigeminal neuralgia is, according to the website of the National Institute of Neurological Disorders and Stroke, "a chronic pain condition that causes extreme, sporadic, sudden burning or shock-like face pain. The pain seldom lasts more than a few seconds or a minute or two per episode. The intensity of pain can be physically and mentally incapacitating. TN pain is typically felt on one side of the jaw or cheek. Episodes can last for days, weeks, or months at a time and then disappear for months or years."
   
   There are two types of trigeminal neuralgia: traditional trigeminal neuralgia and bilateral, meaning it occurs on both sides of the face. Bilateral TN is extremely rare.

Effects

2. Trigeminal neuralgia causes intense pain to shoot across the face. This can be triggered by touching certain parts of the face (different for each patient), or it may be a continuous sharp pain. TN may make eating certain foods or brushing your teeth painful.

Treatment

3. There is no cure for trigeminal neuralgia. There are prescription medications that may be used to treat the symptoms, such as antiseizure medications, anticonvulsant medications, or tricyclic antidepressants. According to the website of the National institute of Neurological Disorders and Stroke, "Typical analgesics and opioids are not usually helpful in treating the sharp, recurring pain caused by TN. If medication fails to relieve pain or produces intolerable side effects such as excess fatigue, surgical treatment may be recommended. Several neurosurgical procedures are available. Some are done on an outpatient basis, while others are more complex and require hospitalization. Some patients choose to manage TN using complementary techniques, usually in combination with drug treatment. These techniques include acupuncture, biofeedback, vitamin therapy, nutritional therapy and electrical stimulation of the nerves."
   
   Promising research has been published linking antidepressants and antiepileptic drugs for the treatments of chronic pain. This study, conducted by Drs. Morris Maizels and Bill McCarberg of Kaiser Permanente in California and published in the February 1, 2005, issue of American Family Physician, was the first to consider certain nontricyclic antidepressants, such as Wellbutrin, for disorders like trigeminal neuralgia. The researchers concluded that "the analgesic effect of these drugs is independent of their antidepressant effect."

Prevalence

4. According to the International RadioSurgery Assocation's website, "Approximately 14,000 people develop TN each year in the United States; about 140,000 people have the condition." The exact cause of trigeminal neuralgia is not known.

Misconceptions

5. Trigeminal neuralgia mainly affects patients who are 50 or older. However, it can occur at any age. Physicians who are not used to treating the disorder may overlook it in a younger patient. Furthermore, there is thought to be a link between trigeminal neuralgia patients who are younger than 50 and multiple sclerosis.
   
   Because of the close proximity of trigeminal neuralgia pain and that of sinus or dental pain, many patients suffer multiple root canals before a diagnosis is made. Often, it is a dental surgeon or ear, nose and throat (ENT) doctor who makes the initial referral to a neurologist.