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trigeminal neuralgia Images (Click to view larger image)
Alternative Names
tic douloureux
Definition
Neuralgia is a term for pain caused by a nerve problem. Trigeminal neuralgia is a painful condition that affects the trigeminal nerve in the face, also called the fifth cranial nerve. This nerve is responsible for sensing touch, pain, pressure, and temperature in the face, jaw, gums, and forehead, and around the eyes.
What is going on in the body?
Nerve pain can affect almost any nerve in the body. Its cause is poorly understood. Some researchers think it is an electrical problem, much like a loose or damaged electrical wire. The fifth cranial nerve gives sensation to almost the entire face. That's why this disorder can cause pain in different areas of the face. Fortunately, treatment can help stop the pain for most people.
What are the signs and symptoms of the condition?
The pain is usually described as sudden, severe, or stabbing. It is commonly felt on one side of the lips, gums, cheek, or jaw. The pain usually lasts for only a few seconds, but it can last for a few minutes. Repeated bouts of pain may occur over a period of minutes. It can recur as often as 100 times a day. Talking, chewing, brushing the teeth, cold temperatures, touching the face, or even swallowing may trigger the pain. The pain can be minor or severe.
What are the causes and risks of the condition?
This disorder is more common in women than men. It rarely affects people younger than 50 years old. In most cases, the exact cause is unknown. In very rare cases, a cause is found for this disorder. These causes include: - injury to the face or oral surgery
- autoimmune disorders, in which the immune system attacks the person's own body. Autoimmune disorders include multiple sclerosis and scleroderma.
- herpes zoster, often called shingles, which is a viral infection that can irritate nerves
- abnormal arteries or blood vessels, which can compress the nerve. One example is an aneurysm, an abnormally widened area in an artery. Malformations of normal blood vessels, called arteriovenous malformations, are another cause.
- tumours or cancer, which may also compress the nerve. In these cases, there are usually other symptoms in addition to nerve pain
What can be done to prevent the condition?
There is no known prevention for trigeminal neuralgia.
How is the condition diagnosed?
There are no specific tests that can diagnose trigeminal neuralgia. The characteristic pain in this condition often allows a doctor to make the diagnosis. Testing may be done to rule out other possible causes of facial pain, such as diseases of the jaw, teeth, or sinuses. For example, an x-ray of the sinuses may be done to rule out a sinus infection.
What are the long-term effects of the condition?
Without treatment, the person may have long-term pain and discomfort. The pain, and fear of the pain, can be so severe that some people cannot perform everyday tasks.
In the rare cases in which the cause is known, other long-term effects can result. For example, cancer can result in death. Multiple sclerosis can cause weakness, paralysis, and permanent disability in some cases.
What are the risks to others?
There are no risks to others.
What are the treatments for the condition?
Treatment for this condition may involve using epileptic medications. These are thought to work by stabilising the nerve. Carbamazepine is usually tried first. If this medication does not work or it causes severe side effects, other medications can be tried. These include phenytoin, baclofen, clonazepam, and valproic acid. If medication fails to control the pain, surgery may be needed.
In the rare case of a known cause, treatment of the cause may stop the nerve pain. For example, surgery may be used to remove a tumour or abnormal blood vessels.
What are the side effects of the treatments?
Side effects of the medications may include nausea, loss of sleep, and headaches. Surgery carries a risk of infection, bleeding, allergic reaction to anaesthesia, and numbness in the face.
What happens after treatment for the condition?
Medication usually makes the pain go away. If surgery is needed, it also usually stops the pain. In the rare case of a known cause, other monitoring or treatment may be needed..
How is the condition monitored?
The person can monitor the pain at home, and report any new or worsening symptoms to the doctor. The medications used often need monitoring. If a medication cannot control the pain, the dose may be changed. If pain cannot be controlled with medications, surgery may be needed. In the rare case of a known cause, other monitoring may be needed. For example, those with cancer need close monitoring of the cancer.
Author: John Riddle
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Contributors
Potential conflict of interest information for reviewers available on request |
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