Tic Douloureux (Trigeminal Neuralgia)

Overview:

Tic douloureux, also known as trigeminal neuralgia, is a relatively common disorder of the fifth cranial nerve characterized by attacks of intense, stabbing pain affecting the mouth, cheek, nose, and/or other areas on one side of the face. These brief episodes of severe shooting pain are caused by irritation of the root of the trigeminal (fifth cranial) nerve.

Symptoms:

The most typical characteristics of this condition include a sudden onset of pain on only the affected side of the face (usually the lower part instead of the upper), with an attack consisting of short-lived, momentary pains that occur over a period of a few seconds to a few minutes. Between these painful episodes, there is no pain. Most people describe the sensation as being "shock like", lightninglike, or like a hot poker. Most patients will have a "trigger zone" -- an area on the face that when touched or stimulated will trigger the pain. In some patients, it may be a certain activity, such as shaving, teeth brushing, or blowing the nose. Some patients think the pain is dental in origin, and will undergo unnecessary teeth extraction (without relief) before the source of the pain is correctly diagnosed.

Causes:

Tic douloureux is not fully understood, but in the vast majority of cases, it appears to be caused by irritation or compression of a the trigeminal nerve, generally from a vessel banging into the nerve. Other causes are quite rare.

Risk Factors:

There are no specific risk factors, but it does affect women at least twice as often as men, is most common in people age 50-70, and occurs in 4-5 people in 100,000.

Diagnosis:

There is no specific test for tic douloureux, and diagnosis is based on the patient’s history and symptoms. The neurological exam is generally normal, as are diagnostic radiology scans (such as MRIs or CT). These radiology scans are sometimes done, however, to eliminate other causes of the pain, such as a tumor or other disease.

Complications:

Tic douloureux tends to come and go, but successive attacks may be more severe and thus more disabling. A patient's fear of being in pain can seriously interfere with daily life. If the pain is associated with eating, there is a danger of unintentional weight loss.

Treatment:

Tic douloureux is the most readily cured chronic pain. Management with medication is always the treatment of choice, as this approaceh is effective in at least half of patients with tic douloureux. The most effective medications are anticonvulsants such as carbamazepine, oxcarbamezepine, phenytoin, or gabepentin. When treatment with medication fails, one of the surgical approaches should be considered. The surgeon will consider the location of the pain, the patients' age and health, and other factors before recommending a specific surgical treatment.

Surgical treatments include: gangliolysis; neurectomy; stereotactic radiosurgery (Gamma Knife); suboccipital craniectomy with microvascular decompression.

Contact Us:

Patients with Tic Douloureux can arrange a clinic appointment by calling 206-598-5637.

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