Trigeminal neuralgia (TN), also called tic douloureux, is a condition characterized by severe facial pain that lasts for a few seconds or minutes and feels like an electric jolt or sharp stab. The pain comes and goes suddenly, and mostly affects one side of the face.
TN is a disorder affecting the trigeminal nerve—the main sensory nerve of the face. There are two types of TN:
- Typical trigeminal neuralgia: The most common type of TN; causing sudden, sharp, and painful attacks in specific areas of the face; mostly involving one side.
- Atypical trigeminal neuralgia: A constant burning and aching pain with sudden sharp pain attacks that are less severe than typical TN and involves a wider area of the face.
The common facial areas affected by TN are the lips, cheeks, jaws, and nose. Less often the eyes, forehead, and temples may also be affected. Atypical TN may affect an entire side of the face, or even both sides of the face together.
Trigeminal Neuralgia Pain
Trigeminal neuralgia is often characterized by one or more of the following symptoms:
- Severe shooting, electric-shock like pain in the face lasting for seconds to minutes that come-and-go frequently; the cycle repeating for days, weeks, or months.
- In between pain attacks, there are periods of no pain till the next attack follows. Sometimes a steady dull ache may be constantly present.
- Daily activities such as shaving, applying make-up, talking, eating, yawning, or even a light breeze can trigger TN pain.
The facial areas involved in TN vary based on the branches of the trigeminal nerve that are affected.
Anatomy of the Trigeminal Nerve
The trigeminal nerve is the largest of the body’s 12 pairs of cranial nerves (nerves that emerge from the brain). There are 2 trigeminal nerves, one for each side of the face. After the trigeminal nerve exits from the base of the brain, it fans out into 3 branches, each supplying specific areas of the face. Depending on the branch affected, the symptoms may occur in different facial regions. The branches of the trigeminal nerve include:
- Ophthalmic branch. This upper branch serves the forehead, eyes, and bridge of the nose
- Maxillary branch. This middle branch serves the upper jaw, upper lip, upper teeth and gums, cheeks, palate, sinuses, temple, and most of the nose
- Mandibular branch. This lower branch serves the lower jaw, lower lip, lower teeth and gums, side and front of the tongue, and part of the ear
Trigeminal neuralgia commonly affects the maxillary and/or mandibular branches, although it is possible for all 3 branches to be affected together. The trigeminal nerve is the fifth cranial nerve and doctors refer to its branches as V1, V2, or V3 (Ophthalmic, maxillary, or mandibular), V referring to the Roman numeral for 5.
The Course of Trigeminal Neuralgia
The main causes of TN include injury or irritation to the trigeminal nerve resulting from the loss of protective coating around the nerve —the myelin sheath, trauma, compression from blood vessels, cysts or tumors in the head, or conditions such as multiple sclerosis.
Over time, TN can get worse by affecting more branches of the trigeminal nerve. The frequency and severity of attacks may increase with fewer pain-free periods between episodes. The treatment of trigeminal neuralgia usually includes medications, but in some cases injections or surgery may be advised.
When Trigeminal Neuralgia Is Serious
TN requires immediate medical attention if neurological symptoms are present, such as numbness, weakness, seizures, vision loss, deafness, difficulty speaking, paralysis, and/or severe headache. Such symptoms may indicate dangerous underlying conditions such as arteriovenous malformations, aneurysms, or brain tumors. A medical professional can make an accurate diagnosis in order to begin a treatment program.