Trigeminal neuralgia (TN) is classified into two types based on the clinical symptoms. The characteristics of both types of TN are discussed below.
Typical Trigeminal Neuralgia Symptoms
The symptoms of typical TN, also called type 1 TN or classic TN, mostly involve one side of the face and occur in episodes. A tingling or numbness in the face may precede a typical TN attack. Common symptoms of typical TN are:
- Severe pain. Sharp, stabbing, or shooting pain on one side of the face that feels like a series of electric shocks and lasts for seconds to minutes. The pain intensity is highest at the start of an episode and lessens rapidly toward the end. It starts and stops suddenly.
- Periods of relief. Pain episodes come-and-go with periods of relief between attacks that may last for hours or days. Sometimes a steady dull ache may be present between episodes with no complete relief.
- Specific areas affected. The facial areas affected follow the pattern of the branch of the trigeminal nerve that is injured or irritated. Commonly the maxillary and mandibular branches are affected, causing symptoms in the lips, cheek, jaw, and nose of the affected side. Less often, when the ophthalmic branch is involved, the eyes, forehead, and temples may be affected.
- Easily triggered. Routine activities such as shaving, brushing teeth, applying make-up, talking, chewing, yawning, or drinking may trigger TN. Specific trigger-points in the face may elicit a pain attack if touched gently or even brushed by light breeze. Some TN episodes may also occur without triggers.
During a TN attack, the pain may cause wincing on the painful side or even a sudden head jerk. The affected side of the face may also have skin turn red, along with excessive eye tearing and/or salivation. The repetitive cycles of pain with breaks in between can last for weeks or months and may be followed by a long pain-free period that can last up to a year or more.
Atypical Trigeminal Neuralgia Symptoms
Atypical TN, also called type 2 TN or symptomatic TN, is less common compared to typical TN. Symptoms of atypical TN are:
- Persistent pain. A persistent dull ache or burning sensation with occasionally sharp come-and-go pains are common in atypical TN. The sharp pain attacks are less severe compared to typical TN and there are also fewer or no periods of relief between pain cycles.
- Widespread pain. Atypical TN has a broader coverage of pain area compared to typical TN. In some cases, both sides of the face may be affected.
- Absence of trigger-points. Although atypical TN is triggered by routine activities involving the face, specific trigger-points that can cause an attack when touched are generally absent.
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Atypical TN can start off as typical TN and over time become a constant burning pain. Pain and frequency of both types of TN may worsen over time and involve more branches of the trigeminal nerve.
Atypical TN is speculated to be caused due to an injury to the motor branch of the trigeminal nerve (instead of the sensory branches as in typical TN). This motor nerve injury could result in delayed pain impulses, resulting in constant burning and less-severe shooting pains compared to typical TN.
Mental Health Impact of Trigeminal Neuralgia
Anxiety from the thought of another TN attack may contribute to chronic fatigue, reluctance to move, and/or always adopting a guarded posture. People often try to avoid, or limit talking, eating, brushing teeth, going to work, and participating in social events. As a result, other problems, such as poor oral hygiene, dehydration, weight loss, fatigue, and/or depression may occur.
It is important to seek immediate medical attention if symptoms of trigeminal neuralgia are experienced. Early treatment helps control symptoms and provides better quality of life, while also preventing progression of the condition.