What is Trigeminal neuralgia (tic douloureux)

Trigeminal neuralgia is a condition that affects the face.

The trigeminal nerve is the main sensory nerve to the face. It has three divisions supplying the three parts of the face in the diagram below – called V1 (mandibular nerve, red), V2 (maxillary nerve, blue), and V3 (opthalmic nerve, green).

Trigeminal neuralgia is an idiopathic condition (of unknown cause) in which there is paroxysmal (acute attacks of) pain in the distribution of branches of the trigeminal nerve on one side of the face.

Statistics on Trigeminal neuralgia (tic douloureux)

The condition chiefly occurs in patients over the age of 50, and is slightly more common in women than men.

Risk Factors for Trigeminal neuralgia (tic douloureux)

The cause of trigeminal neuralgia is usually unknown.

However, in a minority of patients there is an underlying cause:

 

  • Multiple sclerosis
  • Tumours of the trigeminal nerve e.g. neuroma
  • An aneurysm of the basilar artery (next to the trigeminal nerve in the brain);
  • A tumour in cerebellopontine region of the brain;
  • Following an episode of shingles
  • Paroxysms may be brought on by the stimulation of a specific and often tiny trigger zone in the face. Washing, shaving, a cold wind or eating are examples of stimuli that may provoke an attack.

    Progression of Trigeminal neuralgia (tic douloureux)

    An episode of trigeminal neuralgia may be precipitated by activities such as talking, chewing, shaving, brushing teeth or by cold wind on the face. Trigger points may be located around the nose, lips or mouth; and when touched can evoke a paroxysm. This can lead to patients being hesitant about eating and brushing teeth, resulting in problems such as poor dental hygiene.

    Most people remain pain-free between attacks which may be months or years apart.
    As a result of the severe pain, patients may become anxious and withdrawn. Complications include malnutrition, poor dentition, depression, dehydration and even self harm or suicide in severe cases.

    How is Trigeminal neuralgia (tic douloureux) Diagnosed?

    Features in the history alone are usually enough to make the diagnosis.

    Prognosis of Trigeminal neuralgia (tic douloureux)

    Although the attacks often recur, the severity of attacks can be reduced with medications and more invasive procedures which may be useful in difficult cases. The majority of patients will respond to at least one of the treatments and can obtain excellent long-term relief.

    How is Trigeminal neuralgia (tic douloureux) Treated?

     

  • In the majority of patients Carbamazepine 600mg-1200mg daily can reduce the severity of theattacks.
  • Phenytoin, gabapentin and clonazepam can be also used however these are less effective.
  • If medical therapy fails more invasive therapy may be needed. Invasive procedures include nerve blocks, nerve destruction, and nerve decompression techniques.

  • Trigeminal neuralgia (tic douloureux) References

    [1] Barker F, et al. The long-term outcome of microvascular decompression for trigeminal neuralgia. New England Journal of Medicine 1996; 334(17): 1077-1083.
    [2] Hankey G., Wardlaw J. Clinical Neurology. Demos Medical Publishing, United Kingdom, 2002.
    [3] Kumar P, Clark M. CLINICAL MEDICINE. WB Saunders 2002;
    [4] Moore, KL, Clinically orientated anatomy 3rd ed; Williams and Wilkins, 1992
    [5] Murtagh, J. General Practice. Second Ed. McGraw-Hill, 1998.