Definition

Trigeminal neuralgia (TN) is a disorder of the trigeminal nerve (cranial nerve 5) that causes severe, shooting pain along one side of the face. The trigeminal nerve senses touch, pain, pressure, and temperature. It also helps make saliva and tears.

In TN, pain usually lasts for less than a second to a few seconds and may come and go for days, weeks, months, or years. It may go into remission or stop completely for months or years. Over time, though, the attacks may become more frequent and more severe.

Causes

In most cases, the cause is unknown. In some cases, it may be caused by an abnormally formed artery or vein near the nerve. The blood vessel can compress the nerve and cause problems. Rarely, TN may occur as a symptom of another underlying disorder, such as:

• Tumor in the brain or head
• Multiple sclerosis
• Shingles

Risk Factors

TN is more common in women aged 50 years or older. Having certain medical conditions, such as multiple sclerosis or high blood pressure may increase your risk of TN.

Symptoms

The main symptom is searing pain on one side of the face. The pain may be felt inside the mouth or in the lips, cheek, chin, nostril, ear, or near the eye. Rarely, pain may occur in the eye or forehead. Twitching or wincing sometimes accompanies the pain.

The pain is typically sudden, severe, and stabbing. Even though the pain is brief, usually less than two minutes, it can reoccur hundreds of times a day. Attacks can become totally disabling. They may seem to occur at random or be triggered by extremes of temperature, washing, shaving, touching, or tickling the face. There are usually no symptoms between attacks, except perhaps a dull ache.

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. You may have an electrophysiologic test called a trigeminal reflex test. Other tests, such as a CT scan or MRI scan can take evaluate the head and surrounding structures.

You may be given antiseizure medication to help diagnose the disorder.

Treatment

Talk with your doctor about the best treatment plan for you. Options include:

Prevention

There are no current guidelines to prevent TN.

The Facial Pain Association http://www.fpa-support.org

TNAC—Trigeminal Neuralgia Association of Canada http://www.catna.ca

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