Trigeminal neuralgia

Trigeminal neuralgia

Trigeminal neuralgia

Trigeminal neuralgia

It is a chronic pain condition that affects the trigeminal nerve or 5th cranial nerve , largest nerve of the head, which carries the sensation from face to the brain. if there is trigeminal neuralgia even , mild stimulation of the face- such as from brushing your teeth or putting on make-up can increase the pain. This disorder causes extreme burning or shock like  face pain that lasts from few seconds to as long as 2 minutes per episode.

Trigeminal nerve has three branches— the ophthalmic, the maxillary and the mandibular branch. The ophthalmic or upper branch supplies sensation to the scalp, forehead and the front of head. The maxillary or middle branch passes through the cheek, upper jaw, teeth and gums and to the side of  nose and the mandibular or lower branch supplies the lower jaw, teeth gums and bottom lip.. the attacks are said by those affected to feel like an electric shock or sometime a type of crushing pain. In the days before an attack begins, some patients may experience a tingling or numbness or somewhat constant and aching pain. TN occur most often in people over age 50, but it can occur at any age and is more common in women than in men.


What causes trigeminal neuralgia

The presumed cause of trigeminal neuralgia is a blood vessel pressing on the trigeminal nerve as it exits the brain stem. This compression causes wearing away of the protective coating around the nerve(myelin sheath) and cause hyper active functioning of the nerve. This can lead to pain attacks at the slightest stimulation of any area serve by the nerve. TN may be the part of aging process—- as blood vessels lengthen they can come to rest and pulsate against a nerve. TN symptoms can also occur in people with multiple sclerosis. The deterioration causes the nerve to send abnormal signals to the brain. in some cases the cause is unknown and it is said to be (idiopathic) at that time.


Signs and symptoms of trigeminal neuralgia

TN is characterized by sudden, severe electric-shock like pain that is typically felt on one side of the jaw or cheek. Pain may occur on both sides of the face, although not at the same time. The attacks of the pain, which generally lasts several seconds and may repeat in quick successions, come and go throughout the day. These episodes can last for days, weeks or months.

The intense flashes of pain can be triggered by vibration or contact with the cheek(such as when shaving, washing the face or even apply make-up), brushing teeth, chewing, eating, talking or being exposed to wind. The bouts of pain rarely occur at night, when the patient is sleeping. The attacks often worsen over time. Due to intensity of the pain, some patients may avoid daily activities because they fear of impending attacks. There is also a variant type of trigeminal neuralgia called atypical trigeminal neuralgia. This is also called as trigeminal neuralgia type-2. these patients experience severe underlying pain similar to migraine in addition to shock like pain. In some cases pain may be intense like burning sensation rather than shock. Sometime pain occurs in combination of shock like, migraine like or burning type. Firstly pain focused in one spot and then spread in a wider pattern.

Triggers that increases pain

A variety of triggers may set off the pain of trigeminal neuralgia, including


1) shaving

2) stroking your face

3) eating

4) drinking

5) brushing your teeth

6) talking

7) putting on makeup

8) exposure to wind

9) smiling

10) chewing.



Treatment of trigeminal neuralgia

Treatment options include medicines such as anticonvulsants and tricyclic antidepressants. Typical analgesics and opoids are not usually helpful in treating sharp, reoccurring pain caused by TN. If medication fails then surgery should be recommended. Certain techniques like acupuncture , biofeedback, vitamin therapy, nutritional therapy and electrical stimulation of the nerve is beneficial. Sometime alcohol injections provide temporary pain relief by numbing the areas of face.


What will be the prognosis

The disorder is characterized by reoccurrence and remissions. Due to the intensity of pain, even the fear of impending the attack may prevent activity. Trigeminal neuralgia is not fatal.