Trigeminal Neuralgia (Tic Douloureux)

What Is It?

Trigeminal neuralgia, also known as tic douloureux, is a painful disorder of a nerve in the face called the trigeminal nerve or fifth cranial nerve. There are two trigeminal nerves, one on each side of the face. They are responsible for detecting touch, pain, temperature and pressure sensations in areas of the face between the jaw and forehead.

People who have trigeminal neuralgia typically experience episodes of sudden, intense, "stabbing" or "shocklike" facial pain. This pain can occur almost anywhere between the jaw and forehead, including inside the mouth. However, it usually is limited to one side of the face.

In some cases, the cause of trigeminal neuralgia is unknown. In many people, however, the disorder seems to be related to a local irritation of the trigeminal nerve, usually in the area of the nerve root deep within the skull. In most cases, the source of this irritation is believed to be an abnormal blood vessel pressing on the nerve. Less often, the nerve irritation is related to a tumor that involves the brain or nerves, or to a rare type of stroke. In addition, up to 8 percent of patients who suffer from multiple sclerosis (MS) eventually develop trigeminal neuralgia as a result of MS-related nerve damage.

New cases of trigeminal neuralgia affect four to five out of every 100,000 people in the United States each year. It affects women slightly more often than men, perhaps because the disease is most common in older people and women live longer. In most cases, the first episode of facial pain occurs when the patient is 50 to 70 years old. Although infants, children and young adults may develop this disorder, it is rare in people younger than age 40.

Symptoms

Trigeminal neuralgia causes episodes of sudden, intense facial pain that usually last for two minutes or less. In most cases, the pain is described as excruciating, and its quality is "sharp," "stabbing," "piercing," "burning," "like lightning" or "like an electric shock." In most cases, only one side of the face is affected.

The pain of trigeminal neuralgia is recognized as one of the most excruciating forms of pain known. The pain often is triggered by nonpainful facial movements or stimuli, such as talking, eating, washing the face, brushing the teeth, shaving or touching the face lightly. In some cases, even a gentle breeze on the cheek is enough to trigger an attack. Approximately 50 percent of patients also have specific trigger points or zones on the face, usually located somewhere between the lips and nose, where an episode of trigeminal neuralgia can be triggered by a touch or a temperature change. In some cases, a sensation of tingling or numbness comes before the pain.

Attacks of trigeminal neuralgia can vary significantly, and may occur in clusters, with several episodes following in series over the course of a day. For unknown reasons, trigeminal neuralgia almost never occurs at night when the person is sleeping.