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Trigeminal neuralgia

Definition

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, incidence, and risk factors

The pain of trigeminal neuralgia comes from the trigeminal nerve. This nerve carries pain, feeling, and other sensations from the brain to the skin of the face. It can affect part or all of the face, and the surface of the eye.

The condition usually affects older adults, but it may affect anyone at any age. Trigeminal neuralgia may be part of the normal aging process.

Trigeminal neuralgia may be caused by:

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

Often, no specific cause is found.

Doctors are more likely to find a cause if the patient is younger than age 40.

Symptoms

• 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
  • Lightly touching the face
  • Shaving

Signs and tests

A neurologic examination is usually normal.

Tests that are done to look for the cause of the problem include:

• Blood tests
• MRI of the head
• Trigeminal reflex testing

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 (carbamazepine, gabapentin, lamotrigine, phenytoin, valproate, and pregabalin)
• Muscle relaxants (baclofen, clonazepam)
• Tricyclic antidepressants (amitriptyline, nortriptyline, or carbamazepine)

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

• Cutting or destroying part of the trigeminal nerve
• Stereotactic radiosurgery
• Surgery to remove a blood vessel or tumor that is putting pressure on the trigeminal nerve

Support Groups

Expectations (prognosis)

How well you do depends on the cause of the problem. If there is no underlying disease, some people find that treatment provides at least partial relief.

However, the pain may become constant and severe in some patients.

Complications

Calling your health care provider

Prevention

References

Cutrer FM, Moskowitz MA. Headaches and other head pain. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 421.

Goetz CG, ed. Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa: WB Saunders; 2007.

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.