Trigeminal Neuralgia / Face Pain

Trigeminal neuralgia (TN), also sometimes called tic douloureux, is a chronic pain condition that causes extreme, sporadic, sudden burning or shock-like face pain. The likely cause is a blood vessel pressing on the trigeminal nerve as it exits the brainstem. Each attack usually lasts only a few seconds, or a minute or two, per episode, but the intensity of the pain can be physically and/or mentally incapacitating. Episodes may recur for days, weeks or months, and then may not occur again for several months or years. Attacks often worsen over time, with fewer pain-free periods of relief. Patients may also experience a tingling or numbing sensation or a constant ache in the days leading up to an episode.

TN pain is typically felt on one side of the jaw or cheek, and intense flashes of pain can be triggered by vibration or contact with the cheek. Normal, everyday activities such as shaving, washing the face, applying makeup, brushing teeth, eating, drinking, talking, or being exposed to the wind may create a very painful episode.

TN may manifest at any age, but it most often occurs in people over age 50. It is also more common in women than in men. For some people, TN may simply be part of the normal aging process, but in other cases it is associated with another disorder, such as multiple sclerosis or other disorders characterized by damage to the myelin sheath that covers certain nerves. The disorder may run in families, perhaps due to an inherited pattern of blood vessel formation. While sometimes debilitating, TN is not life-threatening.

TREATMENT

Many conditions can cause facial pain, which makes TN difficult to diagnose. Finding the cause of the pain is important, however, because treatment options differ for various types of pain. Medicines such as anticonvulsants and tricyclic antidepressants may be used, but typical analgesics and opioids are not usually successful in treating the sharp, recurring pain caused by TN. In cases where medication does not relieve pain or produces intolerable side effects, surgery may be recommended. Some patients choose to manage TN using complementary techniques— such as acupuncture, biofeedback, vitamin therapy, nutritional therapy or electrical stimulation of the nerves— usually in combination with drug treatment.

PROGNOSIS

TN is not fatal, but because the disorder is characterized by often unpredictable recurrences and remissions, the patient may become incapacitated. Due to the intensity of the pain, even the fear of an impending attack may prevent a patient from engaging in some activities.

Trigeminal Neuralgia (TN)