Pain

What is Trigeminal Neuralgia?

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What is trigeminal neuralgia?

Trigeminal neuralgia is a neuropathic pain condition which develops when damage occurs to a trigeminal nerve. The trigeminal nerves are the main nerves on each side of the face — each side of the face contains one trigeminal nerve. They are responsible for carrying the sensations of pain and touch to the brain from areas of the face including, but not limited to, the mouth, nose and cheeks. When trigeminal neuralgia occurs, even a mild sensation (washing the face, eating a snack or a slight breeze touching the face, etc.) can cause intense pain. Individuals with trigeminal neuralgia often describe the pain as electric shock sensations. The condition is chronic, and the intensity and frequency of pain typically increase over time.

Facial nerves

The human head contains twelve pairs of cranial nerves. The trigeminal nerves are responsible for sensations felt in the face. One trigeminal nerve covers each side of the face. Each nerve divides into three branches:

  • The ophthalmic branch which controls the eyes, upper eyelids and forehead region.
  • The maxillary branch which controls the lower eyelids, cheeks, nostrils and upper gums.
  • The mandibular branch which controls the jaw, lower lip and chewing muscles

The pain felt with trigeminal neuralgia depends on which nerve is damaged. Generally, pain is experienced on one side of the face. The nerves of the mandibular and maxillary regions are most commonly affected, so pain usually occurs around the eyes, ears, nose and lips or inside the mouth.

Types

Trigeminal neuralgia is classified into two types:

  • Type 1 or “classic” type
    Type 1 presents as intense, brief, sudden, blazing facial pain lasting from a few seconds to several minutes. These episodes may occur in quick succession and are very painful.
  • Type 2 or “atypical” type
    Type 2 presents as a persistent stinging, aching, burning soreness of relatively less intensity than type 1. An individual may experience both types of trigeminal neuralgia, sometimes simultaneously.

Symptoms

The major symptom of trigeminal neuralgia is facial pain. The pain can vary in intensity and frequency.

  • Pain characteristics
    The literal meaning of neuralgia is pain originating from a nerve. Pain from trigeminal neuralgia often occurs in jolts and is often severe. The pain is sharp and brief; it has been compared to being pierced by a knife in quick succession. After one jolt, a dull ache remains in the affected area which soon vanishes.
  • Trigger-point pain
    Brief periods of jabbing and sharp pain can be triggered by routine activities, such as shaving, applying makeup and eating. Pain can last from a few seconds to several minutes. The most commonly affected areas are the jaws and cheeks; episodes of pain in and around the forehead are not as prevalent. Trigeminal neuralgia pain generally occurs on one side of the face — rarely on both sides.
  • Intensity of pain
    The pain experienced with trigeminal neuralgia progresses in intensity and frequency over time. The flashes of pain are triggered by contact with sensitive parts of the face. Sudden and potent flashes of pain are signs of “classic” (type 1) trigeminal neuralgia. If the pain is less vigorous but constant, like a flaming aching, then it is usually classified as “atypical” (type 2) trigeminal neuralgia. Pain changes, based on the type of trigeminal neuralgia; it varies from sudden, acute and jabbing to an unceasing, searing sensation.
  • Frequency of pain
    The frequency of pain tends to vary; however, constant pain is never a symptom of trigeminal neuralgia. Pain may occur several times a day or last for weeks with periods of remission between bouts.

Causes and risk factors

In 90 percent of reported cases, the main cause of trigeminal neuralgia is contact or pressure from an artery or vein resulting in nerve malfunction. The consensus of the medical community is that trigeminal neuralgia develops when damage occurs to the protective sheath of a trigeminal nerve which leads to malfunction. Trigeminal neuralgia is more commen after the age of 50, and women are more at risk for developing it than men.

Although rare, trigeminal neuralgia can occur due to an underlying cause, such as a tumor, skull abnormality or multiple sclerosis. In some cases, surgical injuries, strokes, or various traumas may also be responsible for trigeminal neuralgia as they can disturb the normal functioning of nerve impulses. Another cause of trigeminal neuralgia is arteriovenous malformation in which a tangle of various arteries and veins is abnormally formed leading to compression of a trigeminal nerve.

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