Overview
Trigeminal neuralgia (TN) is a chronic pain disorder that affects the trigeminal nerve, which is responsible for sensation in the face. People with TN experience sudden, intense facial pain, often described as a sharp, electric shock-like sensation that can be triggered by everyday activities such as talking, chewing, brushing teeth, or even touching the face lightly. The condition is more common in people over 50 and tends to affect women slightly more than men
A sudden severe facial pain with electric shock-like, stabbing quality that lasts from a fraction of seconds to minutes. It may be triggered by touching, talking, washing face, shaving, brushing teeth, chewing, swallowing, or wind blowing on the face.
― WHS
The exact cause of TN can vary. It is often due to pressure on the trigeminal nerve by a blood vessel, leading to nerve irritation. In some cases, it can result from nerve damage due to multiple sclerosis (MS), a stroke, or facial trauma. TN can also be classified into two types: classical (typically due to vascular compression) and secondary (due to other underlying conditions such as MS or tumors)
Types of Trigeminal Neuralgia:
Classical Trigeminal Neuralgia: this is caused due to compression of blood vessels around the trigeminal nerve. There are no other causes.
Secondary Trigeminal Neuralgia: this is caused by underlying disease such as a tumor, an abnormal tangle of blood vessels connecting arteries and veins, or due to multiple sclerosis. Individuals may suffer from continuous or near-continuous pain.
Idiopathic Trigeminal Neuralgia: all the tests reveal no significant abnormality.
Painful Trigeminal Neuropathy: facial pain in one or more branches of the trigeminal, which carries sensation from face to brain. The pain is usually continuous or near- continuous and is commonly characterized as burning, squeezing, or pins and needles. There is reduced sensation along the branches of the trigeminal and touching the area can be painful. Causes include herpes zoster, post herpetic neuralgia, post-traumatic, multiple sclerosis or tumor.
Diagnosis
- Neurological history and examination.
- 3-t mr imaging of trigeminal nerves using 3d ciss sequences.
- Electrophysiological tests: blink reflex and trigeminal somatosensory evoked potential
Treatment:
Treatment options range from medications, such as anticonvulsants and muscle relaxants, to surgical procedures aimed at relieving pressure on the nerve or blocking pain signals. In severe cases, surgical options like microvascular decompression or radiofrequency rhizotomy may be recommended
- First line: carbamazepine or oxcarbazepine.
- Second line: lamotrigine, baclofen, pregabalin, Gabapentin, topiramate, valproate.
- Neuromodulation: gasserian (trigeminal) ganglion stimulation, peripheral nerve stimulation, invasive motor cortex stimulation and non-invasive cortex stimulation, motor cortex transcranial direct-current stimulation (tdcs), repetitive transcranial magnetic stimulation (rtms).
- Surgical treatment: microvascular decompression, gamma knife radiosurgery, percutaneous procedures on the gasserian ganglion, percutaneous glycerol rhizolysis, radiofrequency thermocoagulation, balloon compression.
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