What is trigeminal neuralgia?

Trigeminal neuralgia (TN), also known as douloureux, is a distinctive facial pain syndrome that may become recurrent and chronic. TN is a form of neuropathic pain (pain associated with nerve injury or nerve lesion.) The typical or “classic” form of the disorder causes extreme, sporadic, sudden burning or shock-like facial pain that lasts anywhere from a few seconds to two minutes per episode. These attacks can occur in quick succession, in volleys lasting up to two hours.

The trigeminal nerve is one of 12 pairs of nerves that are attached to the brain. The nerve has three branches that conduct sensations from the upper, middle, and lower portions of the face, as well as the oral cavity, to the brain.

  • The ophthalmic, or upper, branch supplies sensation to most of the scalp, forehead, and front of the head.
  • The maxillary, or middle, branch stimulates the cheek, upper jaw, top lip, teeth and gums, and to the side of the nose.
  • The mandibular, or lower, branch supplies nerves to the lower jaw, teeth and gums, and bottom lip. More than one nerve branch can be affected by the disorder.
trigeminal nerve

Illustration depicting the trigeminal nerve with its 3 main branches

Signs and symptoms

You may feel as though your pain came out of nowhere. Pain varies and may range from sudden, severe, and stabbing to a more constant, aching, burning sensation. Trigeminal neuralgia symptoms may include

  • Episodes of severe, shooting or jabbing pain that may feel like an electric shock
  • Spontaneous attacks of pain or attacks triggered by things such as touching the face, chewing, speaking and brushing teeth
  • Bouts of pain lasting from a few seconds to several minutes
  • Episodes of several attacks lasting days, weeks, months or longer — some people have periods when they experience no pain
  • Constant aching, burning feeling that’s less intense than the spasm-like pain
  • Pain in areas supplied by the trigeminal nerve, including the cheek, jaw, teeth, gums, lips, or less often the eye and forehead
  • Pain affecting one side of the face at a time, though may rarely affect both sides of the face
  • Pain focused in one spot or spread in a wider pattern
  • Attacks that become more frequent and intense over time

What causes trigeminal neuralgia

In trigeminal neuralgia, the trigeminal nerve’s function is disrupted. TN is associated with a variety of conditions. Usually, the problem is contact between a normal blood vessel — in this case, an artery or a vein — and the trigeminal nerve at the base of your brain. This contact puts pressure on the nerve and causes it to malfunction. This compression causes the wearing away or damage to the protective coating around the nerve (the myelin sheath).

without TN

In people without TN, there is usually no vascular compression upon the trigeminal nerve root.

Trigeminal neuralgia

In most sufferers of typical Trigeminal neuralgia, vessels compress the trigeminal nerve root

generation of TN pain

The generation of TN pain is thought to result from peripheral pathology (i.e. neurovascular compression) and central pathophysiology (i.e. hyperactivity of the trigeminal nerve nucleus).

Trigeminal neuralgia can occur because of aging, or it can be related to multiple sclerosis or a similar disorder that damages the myelin sheath protecting certain nerves. Less commonly, trigeminal neuralgia can be caused by a tumor compressing the trigeminal nerve.

Affected Person

Women are more likely than men to get trigeminal neuralgia. The disorder occurs most often in people over age 50, although it can occur at any age, including infancy. The possibility of TN being caused by multiple sclerosis increases when it occurs in young adults. Although the pain can be intense, the condition is not life-threatening.

Tests and diagnosis

Trigeminal neuralgia is a clinical diagnosis and often no testing is required after the health care professional takes a history of the situation and performs a physical examination which should be normal. Your doctor will diagnose trigeminal neuralgia mainly based on your description of the pain, including:

  • Type. Pain related to trigeminal neuralgia is sudden, shock-like and brief.
  • Location. The parts of your face that are affected by pain will tell your doctor if the trigeminal nerve is involved.
  • Triggers. Trigeminal neuralgia-related pain usually is brought on by light stimulation of your cheeks, such as from eating, talking or even encountering a cool breeze.

Treatments and Medications

To treat trigeminal neuralgia, your doctor usually will prescribe medications to lessen or block the pain signals sent to your brain and keep the nerves from reacting to irritation. These drugs are called anticonvulsants. You also may take muscle relaxants — alone or along with anticonvulsants.

  • Trigeminal neuralgia most often is treated with good success using a single anticonvulsant medication such as carbamazepine.
  • Gabapentin (Neurontin, Gabarone), baclofen and phenytoin (Dilantin, Dilantin-125) may be used as second line drugs, often in addition to carbamazepine.
  • Should pain persist and medication fail to be effective, surgery or radiation therapy may be other treatment options.
  • Lamotrigine (Lamictal) may be prescribed for multiple sclerosis patients who develop trigeminal neuralgia.
  • Deep Braun Treatment: If you have severe trigeminal neuralgia (TN) which has not responded to medication, you may be offered this treatment. It involves delivering an electrical pulse to a part of the brain using a probe. A scanning technique – usually MRI or computed tomography (CT) – is used to make sure the probe is in the right place
  • Decompression surgery: This means an operation to relieve the pressure on the trigeminal nerve

Complementary and alternative treatments that have been used for trigeminal neuralgia such as Acupuncture

Acupuncture Reduces Trigeminal Neuralgia Pain

Acupuncture provides important therapeutic clinical benefits for trigeminal neuralgia patients. A recent investigation finds acupuncture effective in eliminating trigeminal neuralgia symptoms with both a high cure rate and total effective rate.

Researchers conducted a controlled experiment comparing the efficaciousness of carbamazepine with acupuncture. Carbamazepine is an FDA approved anticonvulsant drug used for the treatment of trigeminal neuralgia and is also used for controlling seizures in epileptic patients and mania in bipolar patients. A total of 22 out of 40 patients in the carbamazepine group fully recovered. A total of 30 out of 40 patients fully recovered in the acupuncture group. This yields a 55% cure rate for carbamazepine and 70% for acupuncture.

Acupuncture demonstrated a higher total effective rate than carbamazepine. The total effective rate includes all patient improvements ranging from mild to cured. Carbamazepine achieved an 87.50% total effective rate and acupuncture achieved a 95% total effective rate. Based on the findings, the researchers suggest implementing a Traditional Chinese Medicine (TCM) protocol for patients with trigeminal neuralgia wherein both pharmaceutical medications and acupuncture are combined in a treatment regimen.

References:

Singh, MK. (2016 November). Trigeminal Neuralgia. Medspace. Click for full article

The International Classification of Headache Disorders: 2nd edition. Cephalalgia. 2004. 24 Suppl 1:9-160.Trigeminal neuralgia; NICE CKS,. Click for full article

Trigeminal neuralgia fact sheet. (2013 June). National Institute of Neurological Disorders and Stroke. Click for full article

Longo DL, et al., eds. (2012) Trigeminal neuralgia, Bell’s palsy, and other cranial nerve disorders. In: Harrison’s Principles of Internal Medicine. 18th ed. New York, N.Y. Click for full article

Zakrzewska JM, Linskey ME; (2014 February) Trigeminal neuralgia. BMJ. 348:474. Click for full article

Parmar, M., Sharma, N., Modgill, V., & Naidu, P. (2013). Comparative Evaluation of Surgical Procedures for Trigeminal Neuralgia. Journal of Maxillofacial & Oral Surgery, 12(4), 400–409. Click for full article

Kepeng, C., Long, T. (2015) Clinical discussion on treating primary trigeminal neuralgia, Clinical Journal of Chinese Medicine, (13). Click for full article