TRIGEMINAL NEURALGIA

Trigeminal neuralgia (formerly called Tic douloureux) is a pain affecting the trigeminal nerve (V nerve), which is responsible for transmitting facial sensations.

It’s a chronic condition, which affects more women than men and usually starts in adulthood (after the age of 50).

In up to 95% of cases, a contact or compression is identified by a normal blood vessel, which “irritates” the nerve sheath at its entrance to the brainstem. More rarely, in secondary cases, it can be associated with pathologies such as multiple sclerosis, compressive lesions such as tumours or complications following surgical interventions.

SIGNS AND SYMPTOMS

Trigeminal neuralgia is manifest by episodes of pain that can affect the jaw region, the malar region, the teeth, the gums and, less frequently, the forehead and periorbital region.

It’s characterized by:

Sudden severe pain, lasting a fraction of a second to a few minutes;
Electric shock-like pain;
Seizures can arise spontaneously, but are typically triggered by talking, chewing, brushing teeth or just touching the painful face region - when shaving, for example.

Initially the pain episodes may be mild and short, but trigeminal neuralgia may progress and cause frequent and excruciating attacks of pain, becoming very disabling.

Electric shock-like pain;
Seizures can arise spontaneously, but are typically triggered by talking, chewing, brushing teeth or just touching the painful face region - when shaving, for example.

Initially the pain episodes may be mild and short, but trigeminal neuralgia may progress and cause frequent and excruciating attacks of pain, becoming very disabling.

DIAGNOSIS

Given the location of the pain, patients frequently first resort to dentists with ineffective dental procedures. In fact, the clinical history and neurological examination are essential for a correct diagnosis. The use of complementary imaging tests, namely Magnetic Resonance, are important to identify neuro-vascular contacts or underlying pathology.

TREATMENT

Trigeminal neuralgia pain does not respond usually to common over-the-counter analgesics. It requires specialized medical follow-up and the institution of drugs such as anticonvulsants or antispasmodics is recommended. Dose adjustments should be monitored frequently, taking into account their adverse effects. In some cases, it may be necessary to use botulinum toxin.

In cases refractory to medical therapy, microvascular decompression by surgical approach or radiosurgery (Gamma knife) may be considered.