Trigeminal neuralgia

Definition

Trigeminal neuralgia is very painful swelling (inflammation) of the nerve (trigeminal nerve) that delivers feeling to the face and "surface" of the eye.

Alternative Names

Tic douloureux

Causes, incidence, and risk factors

Trigeminal neuralgia causes severe, short-lasting (only a few seconds) facial pain on the side of the affected nerve. The condition usually affects older adults.

Often, no cause can be found. However, areas of brain swelling or abnormal blood vessels (arteriovenous malformations) can cause it.

Painful trigeminal neuralgia attacks may occur after lightly touching areas of the face that are along the fifth skull (cranial) nerve.

Symptoms

• Very painful, sharp electric-like spasms that last a few seconds or minutes
• Pain is usually only on one side of the face, often around the eye, cheek, and lower part of the face
• Pain may be triggered by touch or sounds
• Pain occurs while:
  • Brushing teeth
  • Chewing
  • Drinking
  • Eating
  • Shaving

Signs and tests

Magnetic resonance imaging (MRI) and blood tests may help rule out other conditions.

Treatment

Certain medicines can help reduce pain and the rate of attacks. These may include:

• Anti-epilepsy drugs (carbamazepine, gabapentin, phenytoin)
• Migraine medicines (sumatriptan)
• Tricyclic antidepressants (amitriptyline, nortriptyline, or carbamazepine)

Some patients may need surgery.

References

Kanai A, Saito M, Hoka S. Subcutaneous sumatriptan for refractory trigeminal neuralgia. Headache. 2006;46(4):577-582.

Goetz CG, ed. Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa: WB Saunders; 2007.