What is Trigeminal Neuralgia(TN) ?

Also known as tic douloureux

Trigeminal neuralgia (TN), is a chronic pain condition that affects the trigeminal or 5th cranial nerve which carries signals from the face to the brain, one of the largest nerves in the head. The trigeminal nerve is one of 12 pairs of cranial nerves that originate at the base of the brain.

It is a condition that causes intense pain similar to an electric shock on one side of the face. Even light touch from brushing your teeth or putting on makeup may trigger a jolt of pain. Trigeminal neuralgia can be long-lasting. It's known as a chronic pain condition.

People with trigeminal neuralgia may at first experience short, mild episodes of pain. But the condition can get worse, causing longer periods of pain that happen more often. It's more common in women and people older than 50.

The intensity of pain can be physically and mentally incapacitating.

Can TN be Treated?

Following an accurate diagnosis by your Doctor, TGN can be effectivly treated with facial and scalp acupuncture.  Acupuncture is a leading alternative treatment for TN. Acupuncture has been used in China for a long time to treat TN and several studies have shown it to be effective.

Research has shown that trigeminal neuralgia study participants felt the most relief after 5 to 6 acupuncture sessions. Typically, we recommend around ten sessions to provide the greatest benefit at 2-3 treatments per week in the beginning, then when pain starts to calm down, treatments can then be spread out to 1-2 per week. 

Treatments your Doctor may recommend include medications or even surgery. 

Trigeminal neuralgia treatment usually starts with medications, and some people don't need any additional treatment. However, over time, some people with the condition may stop responding to medications, or they may experience unpleasant side effects. For those people, injections or surgery provide other trigeminal neuralgia treatment options.

If your condition is due to another cause, such as multiple sclerosis, you need treatment for the underlying condition.

Healthcare professionals often prescribe carbamazepine (Tegretol, Carbatrol, others) for trigeminal neuralgia. It has been shown to be effective in treating the condition.If the anti-seizure medicine you're using becomes less effective, your healthcare professional may increase the dose or switch to another type. Other medications may include muscle relaxants or even Botox injections. Of course all medications come with a list of side effects that may not be tolerable or desirable. 

Surgical options for trigeminal neuralgia include Microvascular decompression. This procedure involves moving or removing blood vessels that touch the trigeminal nerve to stop the nerve from malfunctioning. Microvascular decompression can stop or reduce pain for many years.  Microvascular decompression has some risks, including decreased hearing, facial weakness, facial numbness, stroke or other complications. Most people who have this procedure have no facial numbness afterward.

Brain stereotactic radiosurgery, also known as Gamma Knife. In this procedure, a surgeon aims a focused dose of radiation to the root of the trigeminal nerve. The radiation damages the trigeminal nerve to reduce or stop pain. Pain relief occurs gradually and may take up to a month.

Other procedures may be used to treat trigeminal neuralgia, such as a rhizotomy. In a rhizotomy, your surgeon destroys nerve fibers to reduce pain. This causes some facial numbness. 

Radiofrequency thermal lesioning is a procedure that selectively destroys nerve fibers associated with pain. While you're sedated, your surgeon inserts a hollow needle through your face. The surgeon guides the needle to a part of the trigeminal nerve that goes through an opening at the base of your skull. Radiofrequency thermal lesioning usually results in some temporary facial numbness after the procedure. Pain may return after 3 to 4 years.

Symptoms of TN

Trigeminal neuralgia symptoms may include one or more of these patterns:

  • Episodes of intense shooting or jabbing pain that may feel like an electric shock.
  • Sudden episodes of pain or pain triggered by touching the face, chewing, speaking or brushing your teeth.
  • Episodes of pain lasting from a few seconds to several minutes.
  • Pain that occurs with facial spasms.
  • Episodes of pain lasting days, weeks, months or longer. Some people have periods when they experience no pain.
  • Pain in areas supplied by the trigeminal nerve. These areas include the cheek, jaw, teeth, gums or lips. Less often, the eye and forehead may be affected.
  • Pain on one side of the face at a time.
  • Pain focused in one spot. Or the pain may be spread in a wider pattern.
  • Pain that rarely occurs while sleeping.
  • Episodes of pain that become more frequent and intense over time.

What Causes TN?

In trigeminal neuralgia, the trigeminal nerve's function is disrupted. Contact between a blood vessel and the trigeminal nerve at the base of the brain often causes the pain. The blood vessel may be an artery or a vein. This contact puts pressure on the nerve and doesn't allow it to function as usual.

But while compression by a blood vessel is a common cause, there are many other potential causes. Multiple sclerosis or a similar condition that damages the myelin sheath protecting certain nerves can cause trigeminal neuralgia. A tumor pressing against the trigeminal nerve also can cause the condition.

Some people may experience trigeminal neuralgia as a result of a stroke or facial trauma. An injury of the nerve due to surgery also can cause trigeminal neuralgia.