Trigeminal neuralgia also called Tic Douloureux or Fothergill’s disease is a neuropathic disorder characterized by the sudden, usually unilateral, severe, stabbing type of pain originating from the trigeminal nerve.
The trigeminal nerve is the 5th cranial nerve. The trigeminal nerve is further divided into
- OPTHALMIC NERVE
- MAXILLARY NERVE
- MANDIBULAR NERVE
Signs and symptoms
- It is a sudden , shooting, severe type of pain which increases even on slight touch of certain ‘ trigger points’.
- Triggers are certain areas on the face which when touched or provoked even by slight stimulation, will lead to immense pain. A patient finds it difficult to touch the face at a particular spot, speak or even smile.
- It usually affects only one of the three branches of the trigeminal nerve. All three branches are very rarely affected.
- Pain is restricted to only one half of the face i.e either the right side of the face or the left side.
- The duration of pain is very short (maybe just a few seconds) but it might keep recurring frequently.
- When there is an attack of trigeminal neuralgia the person has an agonizing, unbearable pain. The individual will hold that area of the face with his hand and will not be able to do any activity.
- Even simple jobs like washing the face and shaving the beard become impossible.
- These attacks occur in cycles and it might last for few weeks to few months.
- As time proceeds the frequency of occurrence of these attacks increases. The pain associated with it also increases.
- A lot of times this pain is misunderstood as toothache and unwanted dental treatment is done.
- The most important fact about trigeminal neuralgia that differentiates it from toothache is that it does not occur in sleep.
Treatment
- Anticonvulsant medications like carbamazepine and phenytoin are widely used.
- If carbamazepine does not help in reducing pain and symptoms then sodium valproate can be used.
- Other drugs like Gabapentin and Lamotrigine can also be used.
Surgical treatment includes
- Peripheral neurectomy
- Lingual neurectomy
- Cryotherapy of peripheral nerves.