What is Trigeminal Neuralgia ?

Severe pain on one side of the face due to compression, inflammation, or damage to the trigeminal nerve. The trigeminal nerve transmits sensation from parts of the face to the brain and controls some of the muscles that are involved in chewing. TN (Trigeminal Neuralgia / tic douloureux) is a disorder of the fifth cranial (trigeminal) nerve that causes episodes of intense, stabbing, electric shock-like pain in the areas of the face where the branches of the nerve are distributed - lips, eyes, nose, scalp, forehead, upper jaw, and lower jaw. By many, it's called the "suicide disease". Where lies the Trigeminal Nerve The trigeminal nerve is the fifth of twelve pairs of cranial nerves enervating the face and head, and is denoted by the Roman Numeral V. It has three divisions which enervate the forehead and eye (ophthalmic V1), cheek (maxillary V2) and lower face and jaw (mandibular V3). The trigeminal nerves function in sensing facial touch, pain and temperature, as well as controlling muscles used for chewing. The trigeminal nerve functions should be distinguished from the facial nerve (cranial nerve VII), which controls all other facial movements. The three divisions of the trigeminal nerve come together in an area called the Gasserion ganglion. From there, the trigeminal nerve root continues back towards the side of the brain stem, and inserts into the pons. Within the brain stem, the signals traveling through the trigeminal nerve reach specialized clusters of neurons called the trigeminal nerve nucleus. Information brought to the brain stem by the trigeminal nerve is then processed before being sent up to the brain and cerebral cortex, where a conscious perception of facial sensation is generated. Types of Trigeminal neuralgia There are seven forms of TN: These forms of TN can be distinguished from idiopathic (atypical) facial pain, as well as other disorders causing cranio-facial pain. * Typical TN- This is the most common form of TN, that has previously been termed Classical, Idiopathic and Essential TN. Nearly all cases of typical TN are caused by blood vessels compressing the trigeminal nerve root as it enters the brain stem. * Atypical TN-Atypical TN is characterized by a unilateral, prominent constant and severe aching, boring or burning pain superimposed upon otherwise typical TN symptoms. Some believe atypical TN is due to vascular compression upon a specific part of the trigeminal nerve (the portio minor), while others theorize that atypical TN represents a more severe form or progression of typical TN. * Pre-TN- Days to years before the first attack of TN pain, some sufferers experience odd sensations in the trigeminal distributions destined to become affected by TN. These odd sensations of pain, (such as a toothache) or discomfort (like "pins and needles", parasthesia), may be symptoms of pre-trigeminal neuralgia. Pre-TN is most effectively treated with medical therapy used for typical TN. When the first attack of true TN occurs, it is very distinct from pre-TN symptoms. * Multiple-sclerosis-related TN- Two to four percent of patients with TN have evidence of multiple sclerosis and about 1% of patients suffering from multiple sclerosis develop TN. Those with MS-related TN tend to be younger when they experience their first attack of pain, and the pain progresses over a shorter amount of time than in those with typical TN. Furthermore, bilateral TN is more commonly seen in people with multiple sclerosis. * Secondary TN or Tumor Related Trigeminal Neuralgia- Trigeminal neuralgia pain caused by a lesion, such as a tumor, is referred to as secondary trigeminal neuralgia. A tumor that severely compresses or distorts the trigeminal nerve may cause facial numbness, weakness of chewing muscles, and/or constant aching pain (also see Trigeminal Neuropathy or Post-Traumatic Trigeminal Neuralgia). * Trigeminal Neuropathy or Post-traumatic TN (trigeminal neuropathy)- Trigeminal Neuropathy or Post-Traumatic TN may develop following cranio-facial trauma (such as from a car accident), dental trauma, sinus trauma (such as following Caldwell Luc procedures) but most commonly following destructive procedures (rhizotomies) used for treatment of TN. Following TN injury, numbness may become associated with bothersome sensations or pain, sometimes called phantom pain or deafferentation pain. These pain conditions are caused by irreparable damage to the trigeminal nerve and secondary hyperactivity of the trigeminal nerve nucleus * Failed TN- Unfortunately, in a very small proportion of sufferers, all medications, microvascular decompression and destructive rhizotomy procedures prove ineffective in controlling TN pain. This condition is called "failed" trigeminal neuralgia. Such individuals also often suffer from additional trigeminal neuropathy or post-traumatic TN as a result of the destructive interventions they underwent. Causes of Trigeminal neuralgia The pain of trigeminal neuralgia is due to a disturbance in the function of the trigeminal nerve, which carries sensation from the face to the brain. The cause of the pain is often unknown. But, the pain may occur when a blood vessel comes in contact with the trigeminal nerve. This places pressure on the main part of the nerve as it enters the brain. Besides pressure by a blood vessel, other less frequent sources of pain to the trigeminal nerve may include: * Compression by a tumor. * Inflammation, swelling and injury of the covering (myelin sheath) of the trigeminal nerve in a process called demyelination. This occurs in people with multiple sclerosis who develop trigeminal neuralgia. Symptoms of Trigeminal neuralgia Damage to this nerve causes repeated bursts of sharp, stabbing pain, known as trigeminal neuralgia, in the lip, gum, or cheek on one side of the face. Attacks may last for a few seconds or several minutes and may become more frequent over time. An attack may occur spontaneously or be triggered by certain facial movements, such as chewing, or by touching a trigger spot on the face. Attacks rarely occur at night. People who have experienced severe trigeminal neuralgia have described the pain as: * Lightning-like * Shooting * Jabbing * Like having live wires in your face It's possible for the pain to occur on both sides of your face, but trigeminal neuralgia usually affects just one side. The pain may affect just a portion of one side of your face, or the pain may spread in a wider pattern. The condition also tends to come and go. You may experience attacks of pain off and on all day, or even for days or weeks at a time. Then, you may experience no pain for a prolonged period of time.