Trigeminal Neuralgia

Although relatively uncommon (5 people in 100,000), Trigeminal Neuralgia (TN) has been described as one of the most painful conditions that a person can suffer from. In the past it has also been called tic douleureux. It comes from irritation of the Trigeminal Nerve, which provides sensation to the structures of the jaw, mouth and face. There are two types, Typical and Atypical Trigeminal Neuralgia.

Typical Trigeminal Neuralgia

(TN) is characteristically described as a sharp or electrical lancinating pain that is set off by a trigger area within the area innervated by the trigeminal nerve. There is not usually any residual pain as it is an all or nothing sensation. The exact cause of TN is unknown. Studies have shown that for some people impingement of the nerve by blood vessels close to the brain can contribute to this disorder. TN is often misdiagnosed as a toothache as the most common trigger areas are within the mouth. This can lead to unnecessary dental treatment, which often leads to an unnecessary dental extraction. An MRI of your brain will also need to be done to rule out intra-cranial pathology. The treatment of choice involves quieting the trigeminal nerve with medications such as Neurontin or Tegretol. As many of these medications have effects on the major organs it is important that a person have a complete physical by their physician. Additionally, any irritations of the nerve by pain impulses coming from jaw muscles, teeth, migraines also need to be addressed. Acupuncture and therapeutic injections can be of some additional benefit as well. Should these more conservative treatments not satisfactorily control the pain, then surgical interventions will be discussed and a consultation with a neurosurgeon will be supplied. Surgical intervention would be most appropriate in younger healthier patients as side effects commonly include facial numbness and less commonly death. The longer TN is allowed to continue the worse the long-term prognosis.

Atypical Trigeminal Neuralgia

typically this has a more continuous localized aching pain within the orofacial region that intermittently can have the classic sharp or electrical lancinating pain. There is some association with past traumas to the trigger area. Interestingly, although uncommon, these traumas need not be major such as an automobile accident or punch in the face, but can result from relatively benign traumas such as one receives when they get a root canal or dental filling. This disorder if caught in its early stages can be more easily treated with better long-term outcome than classical TN. However, if problem has long-term chronicity with failed treatment, Atypical TN can have a worse prognosis, as surgical interventions have not been very successful. Medications and therapeutic injections may be of greater benefit in this disorder.