TN - the condition
What is Trigeminal Neuralgia?
Trigeminal Neuralgia (TN) is an extremely severe facial pain that tends to come and go unpredictably in sudden shock-like attacks. The pain is often described as stabbing, shooting, excruciating, burning, extremely strong. The pain usually lasts for a few seconds, but there can be many bursts of pain in quick succession. It is a chronic disorder of the trigeminal nerve (or 5th cranial nerve).
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The trigeminal nerve has 3 branches (or divisions): the upper 1st branch (Ophthalmic) which runs above the eye, forehead and front of the head; the middle 2nd branch (Maxillary) which runs through the cheek, upper jaw, teeth and gum, side of the nose; the lower 3rd branch (Mandibular) which runs through the lower jaw, teeth and gums. TN can involve one or more branches. Most frequently, the middle and lower branches are affected. The majority of people affected are over 50 years old, but many cases have been reported in young adults, and very rarely among children. It affects women more than men, and it is more often on the right side of the face. It is not hereditary.
What are the causes of Trigeminal Neuralgia?
This is still an area of discordance among the medical professionals. Most of them believe that the deterioration of the myelin (protective coating of the nerve) allows the transmission of abnormal messages of pain. The damage of the myelin sheath may be caused by pressure from blood vessels or arteries, tumours, Multiple Sclerosis, injury to the nerve, consequences of shingles, or just the ageing process.
Unfortunately in some cases a cause may not be found. There are quite a few sufferers who never find relief, although the majority do.
Diagnosis
If after several visits to a dentist, a GP or an ear-nose-throat specialist, TN is suspected, the patient is sent to a neurologist. He will perform some neurological tests to rule out or discover other diseases. He will also ask you for a precise description of the pain. Most doctors will recommend a MRI scan in order to see if there is any obvious cause for the pain.
Classic TN
Spasms of sharp, stabbing pain, often described as like a jolt of lightning The pain is confined to the area served by the branches of the TN nerve: lower jaw, upper jaw, cheek, eye, and forehead. The pain may include one, two or all three branches of the TN nerve. Pain is almost always on one side of the face, most commonly the right-hand side. The pain is usually provoked by a light touch on the face, movements of the face (and therefore of the mouth), touching the side of the nose or even a light breeze. Trigger points are usually around the nose and lip. The pain might disappear by itself for weeks, even months, and then return.
Atypical TN
Aching, burning pain, mainly in the cheek, upper jaw and sometimes lower jaw. It is less likely to happen in the eye and forehead area. A trigger point is more difficult to define than in classic (typical) TN. Sometimes, after a long period, classic TN can also be accompanied by atypical TN. This leads to a combination of the sharp, electric shock-like pain plus the dull aching pain.
Downloadable booklet: Trigeminal Neuralgia - An Overview
This page was updated on 23 July 2009
