|Young Bui, D.D.S.
NEURALGIA (TN) is a sudden electric-shock-like pain that occurs on one
side of the face and is spasmodic. The pain usually comes in short
bursts, lasting for only a few seconds, and may repeat many times over
the course of the day. Several attacks can follow one another within
minutes. There can be periods of remission, which can last from days
to years, when pain is completely absent, but without medical treatment
the pain usually returns. One of the causes of TN is pressure exerted
on the trigeminal nerve by a blood vessel or tumor. Another is demyelinization
of the nerve in patients with multiple sclerosis. Dental and surgical
procedures, injury to the face, or infections can cause physical damage
to the nerve, resulting in TN. Trigeminal neuralgia pain is often
triggered by certain stimuli, such as touching the face, eating, talking,
or shaving. This condition affects 150 out of 1 million people worldwide.
The area of facial pain is reflected according to
the branch of the trigeminal nerve that is affected. Shooting pain
to the eye, forehead, and nose would indicate a problem with V1, the ophthalmic
branch. A V2 (maxillary) problem would send shooting pain to the
upper teeth, gum and lip, the side of the nose, lower eyelid, and cheek.
The lower teeth, gum, lip, and jaw are affected by V3 (mandibular).
One or more of the branches can be involved at the same time.
“Classic” TN Pain
In classic TN as described in medical literature, the
pain is extremely sharp, throbbing, and shock-like. There is no facial
numbness or weakness. With classic TN pain, there are distinct periods
of remission, when there is no pain at all. Classic TN generally responds
well to Tegretol, an anti-convulsive drug used to treat seizure disorders.
Atypical TN Pain
One typical feature of TN is that it is rarely typical.
For many TN patients, the condition does not conform to the symptoms of
“classic” TN. In addition to the stabbing shock-like pain, many victims
experience various kinds of pain that they may describe as throbbing, burning,
crushing, or pulsating. For some, there are no remissions from the
pain. These “atypical” forms of TN are often very difficult to treat.
A thorough medical exam should be performed and history
of symptoms taken along with medical tests to rule out any serious medical
problems. These tests can include a CAT scan or MRI. In some cases,
high-definition MRI angiography (MRTA) of the trigeminal nerve and the
brain stem can identify where the nerve is compressed by a vein or artery
but more often than not, no cause is found for the pain. If the pain is
diminished with carbamazepine (Tegretol) treatment, this is a positive
indicator for a diagnosis of TN. A special MRI technique, 3-D volume acquisition,
performed with contrast injection, can detect 80 percent of the time whether
a blood vessel pressing on the trigeminal nerve is causing TN pain.
However, up to now, no medical test exists that clearly diagnoses all cases
Initial treatment for TN is usually medication with
carbamazepine, Tegretol® being the drug of choice. Other drugs, such
as baclofen (Lioresal®), clonazepam (Klonopin®) and gabapentin (Neurontin®)
are often used alone or in combination. Trileptal, a drug which was recently
approved for use in the US, appears to have fewer side-effects than Tegretol
and is often effective in controlling TN pain. When medication fails, surgery
may be considered.
This excerpt has been taken from the website
Please refer to that site for more information.
Dorweiler, Bryce D., Trigeminal Neuralgia
January - March 2006
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