Trigeminal Neuralgia (TN or TGN)
Download Trigeminal Neuralgia Facts
Often called tic douloureaux (French for “painful tic”), TN
or TGN is an excruciatingly painful condition that affects one side of
the face in the divisions of the fifth cranial (trigeminal) nerve.
VIDEO: TRIGEMINAL NEURALGIA (TGN)
This chronic condition is caused by a misfiring of the trigeminal nerve.
An attack causes brief episodes of extreme, shooting pain. TGN most commonly
affects older people.
TGN is characterized by one-sided, short-lasting episodes of intense, stabbing,
electric shock-like pain in the areas of the face where the three branches
of the nerve are distributed (i.e., in the lips, eyes, nose, forehead,
and the jaw). The pain is also commonly felt in the mouth mimicking toothache,
often misleading clinicians to recommend irreversible dental treatments
such as root canal therapy and extractions that do not address the source
of the problem. The pain can be spontaneous or triggered by light touch,
eating, chewing, talking, shaving, washing the face, or a breeze against the face.
Initially, the disorder may present with less intense, longer-lasting,
dull ache (easily confused with TMJ disorders) or mild to moderate burning
pain with occasional superimposed stabs of electric-like pain. Pain triggers
may or may not be present in this early state of the disease sometimes
referred to as “pre-trigeminal neuralgia.”
The primary cause of TGN is damage to the protective covering of the nerve
fibers in the brain stem, usually due to an artery pressing against the
nerve. The average age of onset is typically between 40-70 years. Other
causes of TGN include diseases that also damage the covering layer around
the trigeminal nerve fibers, such as brain tumors or multiple sclerosis
(MS), especially seen in younger patients.
Treatment options for TGN
Before any treatment is rendered, a definitive diagnosis must be made by
a specialist with focused expertise in facial pain conditions. Initial
treatment of TGN is usually by means of anti-epileptic drugs. Other classes
of medications, including anti-depressants may be used in some cases.
Should medical management be ineffective or produce undesirable side effects,
neurosurgical procedures are available to treat TGN.
Since there are several modes of surgical and non-surgical interventions
available, each patient will be evaluated individually based on health
status and severity of the disease. Treatment options range from nerve
blocks/injections, percutaneous surgery (through the skin), brain surgery,
and focused gamma radiation treatment. Each procedure has certain advantages
and disadvantages: ease of the procedure, effectiveness, long-term results,
recurrences, complications, etc. All factors will be considered carefully
and discussed thoroughly with the patient, so an informed decision can
be made. There is no one medical or surgical treatment that is effective
in all patients.