(Tic Doleureux)En Español (Spanish Version)
Trigeminal neuralgia (TN) is a disorder of the trigeminal nerve (fifth cranial nerve) that causes severe, shooting pain along one side of the face. The trigeminal nerve senses touch, pain, pressure, and temperature. It also helps make saliva and tears.
The Trigeminal Nerve
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In TN, pain usually lasts for less than a second to a few seconds and may come and go for days, weeks, months, or years. It may go into remission or stop completely for months or years. Over time, though, the attacks may become more frequent and more severe. Attacks can be brought on by chewing, washing, shaving, touching, or even a breeze on the face.
In most cases, the cause is unknown. In some cases an abnormally formed artery or vein near the nerve is the culprit. The blood vessel can compress the nerve and cause problems. Rarely, TN may occur as a symptom of another underlying disorder, such as:
These factors increase your chance of developing TN. Tell your doctor if you have any of these risk factors:
The main symptom is searing pain on one side of the face. The pain may be felt inside the mouth or in the lips, cheek, chin, nostril, ear, or near the eye. Rarely, pain may occur in the eye or forehead. Twitching or wincing sometimes accompanies the pain.
The pain is typically sudden, severe, and stabbing. Even though the pain is often brief (less than two minutes) it can reoccur hundreds of times per day. Attacks can become totally disabling. They may seem to occur at random or be triggered by extremes of temperature, washing, shaving, touching, or tickling the face. There are usually no symptoms between attacks, except perhaps a dull ache.
The doctor will ask about your symptoms and medical history. A physical exam will be done.
Tests may be done to help diagnosis underlying conditions that may lead to TN. These may include:
- CT scan —a type of x-ray that uses a computer to make pictures of structures inside the head
- MRI scan —a test that uses magnetic waves to make pictures of structures inside the head
You may be given the antiseizure medication (eg, carbamazepine ). This medicine may reduce pain and is sometimes used to help diagnose the disorder.
Treatment usually begins with medicine. If medicine fails, other options are available.
Medicines may include:
- Other antiseizure medicines (eg, phenytoin , gabapentin , lamotrigine , oxcarbazepine , pregabalin , topiramate )
- Low-dose antidepressants (eg, amitriptyline , clomipramine )
- Muscle relaxer (eg, baclofen )
- Other medicines, such as sumatriptan (Imitrex) injection, lidocaine nasal spray, pimozide (Orap)
Surgical options include:
- Surgery to remove an artery or tumor that is pressing on the nerve
- Surgery to cut the trigeminal nerve
Surgery can be highly effective in some cases. The most common procedure is microvascular decompression.
These procedures may be somewhat less effective than microvascular surgical decompression. But, they are widely used, especially in older patients.
There are no guidelines for preventing TN. However, once you have it, steps that may help prevent attacks include:
- Eating soft foods
- Eating food and drinking beverages that are room temperature
- Washing your face with cotton pads and warm water
- If tooth brushing triggers attacks, rinsing your mouth with warm water after eating
- Avoiding or minimizing known triggers (eg, heat, cold, touch)
American Chronic Pain Association
American Pain Foundation
The Facial Pain Association
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Last reviewed June 2012 by J. Thomas Megerian, MD, PhD, FAAP
Last updated Updated: 06/04/2012
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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