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Trigeminal neuralgia is a chronic pain condition characterized by intense sometimes physically and mentally incapacitating pain in the head and face.
The fifth cranial nerve or the trigeminal nerve is one of 12 pairs of nerves attached to the brain. The trigeminal nerve branches to the upper, middle, and lower portions of the face and conducts sensations between these branches and the brain. Trigeminal neuralgia, also known as tic douloureux, is a chronic pain condition that affects this nerve. It usually begins as a series of small episodic attacks that often progresses to longer more debilitating attacks.
There are two types of trigeminal neuralgia. The most common type of the disorder is called Type 1 or TN1. It causes intermittent burning spasms of facial pain that may occur in quick succession, lasting from a few seconds to minutes. The duration of the entire episode may be two hours or more.
Type 2 or TN2 is less common. Its symptoms include burning, aching, stabbing pain. The pain may be less intense than the pain experienced with Type 1, but the spasms may occur for longer periods.
Individuals may experience both Type 1 and Type 2 at the same time.
Trigeminal neuralgia may be caused by a variety of conditions. It is most often associated with conditions that affect or damage the myelin sheath, the protective coating around the nerve. The myelin sheath may be damaged by a physical irritation, such as a blood vessel pressing on the trigeminal nerve, or it may be affected by a disease, such as multiple sclerosis. Sometimes, but infrequently, a tumor will lead to trigeminal neuralgia. There is no evidence that trigeminal neuralgia originates with mental disorders.
Although some therapies may alleviate the symptoms of trigeminal neuralgia. There is no definitive cure.
Facial pain can originate from many different disorders. Usually a diagnosis of trigeminal neuralgia can be made only when these other disorders are ruled out. Sometimes an MRI will show blood vessel compression upon the nerve; however, this compression is not always visible on an MRI.
Individuals may experience the pain of trigeminal neuralgia in different ways. Usually it affects only one side of the face, but it sometimes occurs on both sides. Any kind of facial movement can trigger an episode. Before the pain develops, individuals may feel a tingling or numbness in the face. At onset the pain is most frequently described as stabbing, shocking, or piercing. Sufferers may feel the pain in the upper or lower jaw or cheeks. Sometimes pain will occur in the eye or the forehead.
For those with TN1 pain spasms may last from a few seconds to minutes. Some people will feel a dull ache between the spasms.
For those with TN2 the pain is experienced as a constant burning spasm.
These spasms may occur regularly for several days, weeks, or months. Sometimes the pain will disappear completely and not reoccur for months or years. It is not unusual for the space between episodes to decline and the episodes to become more frequent over time.
The pain from trigeminal neuralgia can be extremely debilitating and may also lead to depression and sleep disturbances
Although Trigeminal neuralgia can occur at any age, it most often occurs in those over fifty. When it occurs in young adults there is a greater likelihood that it may be associated with multiple sclerosis. The condition affects women more often than men. Approximately 12 per 100,000 people are diagnosed per year.
Patients may seek relief from conservative techniques, interventional injections, medications, surgeries, or some alternative methods.
Yoga, exercise, creative visualization may help manage the symptoms of trigeminal neuralgia.
There are some medications that may provide relief for trigeminal neuralgia. Anticonvulsant medications often help Type 1 but are less effective in treating Type 2. Trycyclic antidepressants may help with pain. Opioids may sometimes help alleviate the pain of TN2, but have less effectiveness with TN1.
Several surgical procedures may provide relief from the pain. Most of these procedures focus on damaging the nerve fibers to stop or cut the pain signals. Other procedures may attempt to move away a vessel that is compressing the nerve. Many of these procedures carry a risk of facial numbness among other things.
Trigeminal nerve block may interrupt the nerve signals and end an episode. Two types of nerve blocks are used:
*Novocaine and steroid block
*Botulinum toxin block.
Accupuncture, chiropractic, biofeedback, vitamin therapy, nutritional therapy, aroma therapy, meditation