Sometimes known as tic douloureux, trigeminal neuralgia is a condition where pain comes from the trigeminal nerve, which splits in three – toward the eye, cheek and jaw – and starts near the top of the ear. Clearly there are trigeminal nerves on each side of the face, but trigeminal neuralgia pain most commonly affects only one side.
And that’s the most comforting thing about it.
The pain of trigeminal neuralgia is unlike any other facial pain. Its severity is such that the affected person is momentarily paralysed although the agony travels the pronged nerve in a matter of seconds. The sensation is variously described as lancinating, a stabbing ice trident, and a 240-volt punch and as the condition progresses so can the pain.
To call trigeminal neuralgia tic douloureux (meaning painful tic) is lower middle class social climber Hyacinth Bucket insisting the pronunciation is ‘Bouquet’. It’s describing Ishtar, goddess of love and war, as a hot crankypants and blaming only Viktor Bryukhanov for Chernobyl.
In most cases, TN type 1 (as it’s also known) develops from a blood vessel pressing against the trigeminal nerve, and sometimes no underlying cause can be identified. It is a sporadic, intensely sharp, throbbing, burning shock-like pain around the eyes, lips, nose, jaw, forehead and scalp. Its progression brings pain more frequently, and for longer. TN2 (because of course there’s one) can also be idiopathic, can also be a compression of the trigeminal nerve, or can have a known underlying cause like a tumour, Parkinson’s disease or multiple sclerosis. The trigeminal nerve can also be injured through surgery, accident, or stroke. It can run in families because of how blood vessels are formed in the brain.
It can also be linked to high blood pressure, and is more common in people over 50 years of age.
But wait.. there’s more: atypical TN, or TN type 2. It is often caused by infection, or demyelinating disease; which is any condition that damages the myelin sheath (a protective covering) that surrounds brain, optic and spinal cord nerve fibres.
TN type 2 has the pain as a constant: a relentless and burning ache that can also jolt with stabbing pains of less intensity than TN1.
Yippee, I bet. Like the choice between a sword and a thousand paper cuts.
Damaged nerve impulses slow or even stop, causing neurological problems. An impinging vein, artery, or tumour can compress the trigeminal nerve and symptoms are often confused with dental issues and sometimes for a prolonged period of time.
Wow. So healing to all sufferers – whichever category the TN, and whatever form that curative takes.
Thankfully (unless it’s you, I guess) trigeminal neuralgia is a rare condition. While exact numbers are unknown, researchers estimate between 10,000 and 15,000 cases are diagnosed every year. The probability of many cases being attributed to and treated as a dental issue further confounds the approximation.
Whatever the stats I’m glad I’m not one – nor you, I trust.
Although early descriptions of TN can be inferred from the 2AD writings of Greek physician Galen, Aretaeus of Cappadocia – considered second only to Hippocrates. Persian polymath and physician Avicenna, of the Islamic Golden Age recorded similar observations in the 11th century (tortura oris). Nicolas Andre ́ coined the term tic douloureux in 1756, but the first accurate description of TN was officially documented by John Fothergill in 1773, and it became known as ‘Fothergill’s disease’. He recorded that light touch was the most common trigger. He examined 14 cases and attributed the cause to a ‘cancerous acrimony’ because of the persistent and incurable pain. He noted that it was more common in women and the elderly.
The disorder can affect any of the three nerve branches: ophthalmic that controls the eye, upper eyelid, and forehead; maxillary – lower eyelid, cheek, nostril, upper lip, and upper gum; and mandibular that controls jaw, lower lip, lower gum and muscles used for chewing. As mentioned, ordinarily the pain is limited to one side of the face, but bilateral trigeminal neuralgia where it affects both sides can also occur.
What symptoms manifest?
Other than brief periods of shooting pain, it may present as triggered pain from simply blowing your nose, brushing your teeth, washing your face, shaving, or putting on makeup. Even a light breeze can be enough. Pain will be felt mostly along the cheek, jaw, teeth, gums and lips; the forehead and eyes are less routinely affected. After an episode, there’s often uncontrollable face twitching.
Trigeminal neuralgia is a condition that can also create anxiety because of the uncertainty of when the agony will return. Although the pain can be intense, the condition is not life threatening and there are treatments available.
Expect the doctor to ask a lot of questions about your symptoms. You may also have a neurological exam, and an MRI to identify the underlying cause.
Anti-convulsant medication and muscle relaxants are often prescribed, Botox can be suggested, and there are surgical options.
Acupuncture, yoga, and chiropractic treatment have also proven successful in many cases, so there are choices beyond pharmaceuticals and medical intervention.
Your body, and its trillions of cells, respond to all information from your brain – including what you think. Equally concerning and empowering. Even science shows negative and troublesome beliefs predispose the body to illness and that positivity is healing and curative.
Just words, I know – in the same way that pain is just sensation. You are the gatekeeper of your mind, and it’s useful to be protective about how you perceive and process. So manifest good health for yourself just … because.
Because you can, because why not, and because it serves you.
Note: All content and media on the New Gisborne Dental House website and social media channels are created and published online for informational purposes only. It is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice.