Trigeminal Neuralgia, also called Tic Douloureux, is a condition that affects the main nerve in your face (the 5th cranial nerve). It causes sudden, severe bursts of pain in one or more parts of your face that the nerve controls.

The Branches of the Trigeminal Nerve

The trigeminal nerve has three main parts:

• Ophthalmic: This branch goes to your forehead, eyes, nose, the coverings of the brain, the sinuses around your nose, and part of the inside of your nose.

• Maxillary: This branch goes to your upper jaw, teeth, lip, cheeks, the roof of your mouth, the sinuses in your upper jaw, and part of the inside of your nose.

• Mandibular: This branch goes to your lower jaw, teeth, lip, the inside of your cheeks, your tongue, part of your outer ear, and the coverings of the brain.

Types of Facial Pain

• Trigeminal neuralgia, type 1 (TN1): This is when the facial pain comes on suddenly and is mostly temporary, lasting only during an episode.

• Trigeminal neuralgia, type 2 (TN2): This is when the facial pain comes on suddenly but is mostly constant.

• Trigeminal neuropathic pain (TNP): This facial pain is caused by accidental damage to the trigeminal nerve, like from a facial injury, surgery on your mouth, ears, nose, or throat, nerve damage after surgery near the base of your skull, or a stroke.

• Trigeminal deafferentation pain (TDP): This facial pain happens in an area that feels numb because of intentional damage to the trigeminal nerve during treatments like cutting nerves or using heat or radiation.

• Symptomatic trigeminal neuralgia (STN): This pain is caused by multiple sclerosis.

• Post-herpetic neuralgia (PHN): This pain is caused by a shingles outbreak affecting the trigeminal nerve.

• Atypical facial pain (AFP): This pain is thought to be more related to psychological factors than a physical cause.

What Causes Trigeminal Neuralgia?

1. Nerve Compression:

   • Explanation: Something is pressing on the trigeminal nerve, usually a blood vessel, which irritates it and causes pain signals.

   • Example: A blood vessel pressing on the trigeminal nerve.

2. Damage to the Nerve’s Covering:

   • Explanation: The protective covering around the trigeminal nerve (myelin sheath) is damaged, which messes up how the nerve works.

   • Example: This kind of damage is seen in conditions like multiple sclerosis.

3. Herpes Virus Infection:

   • Explanation: The herpes virus infects or reactivates in the trigeminal nerve, leading to swelling and pain.

   • Example: Shingles (herpes zoster) affecting the trigeminal nerve.

4. Infection in Teeth or Jaw:

   • Explanation: Infections in your teeth or jaw can cause swelling and irritate the trigeminal nerve.

   • Example: A tooth infection spreading to the trigeminal nerve.

5. Irritation from Being Sick:

   • Explanation: Getting sick with something like the flu can cause inflammation that affects the trigeminal nerve.

   • Example: Feeling more sensitive and irritated during or after a viral illness.

6. Injury to Teeth or Jaw:

   • Explanation: A physical injury to your teeth or jaw can irritate the trigeminal nerve.

   • Example: Nerve irritation after a dental injury that leads to neuralgia.

7. Bulging Blood Vessel Pressing on the Nerve:

   • Explanation: An enlarged artery (aneurysm) presses on the trigeminal nerve.

   • Example: An aneurysm pressing on the nerve.

8. Tumor:

   • Explanation: A growth (tumor) near the trigeminal nerve presses on and irritates it.

   • Example: A tumor affecting the trigeminal nerve.

9. Hardening of Arteries Near the Nerve:

   • Explanation: Changes in the walls of arteries close to the trigeminal nerve can sometimes cause pressure.

   • Example: Hardening of the arteries affecting vessels near the trigeminal nerve.

Things That Can Trigger Pain:

1. Light Touch:

   • Explanation: Even a gentle touch or a breeze on your face can cause intense pain because the nerve is so sensitive.

   • Example: Lightly brushing your face causing severe pain.

2. Eating:

   • Explanation: Chewing can trigger the pain.

   • Example: Pain while or after eating.

3. Swallowing:

   • Explanation: The movement involved in swallowing can cause pain.

   • Example: Pain when swallowing food or liquids.

4. Talking:

   • Explanation: Moving your face while talking can trigger pain.

   • Example: Pain while having a conversation.

5. Sneezing:

   • Explanation: The force of a sneeze can cause intense facial pain.

   • Example: Pain during or after sneezing.

6. Shaving:

   • Explanation: The act of shaving can irritate the nerve and cause pain.

   • Example: Pain when shaving.

7. Chewing Gum:

   • Explanation: The repeated movement of chewing gum can make the pain worse.

   • Example: Pain when chewing gum.

8. Brushing Teeth or Washing Face:

   • Explanation: Touching your face while brushing or washing can cause pain.

   • Example: Pain while brushing your teeth or washing your face.

9. Exposure to Wind:

   • Explanation: Being sensitive to wind can trigger pain.

   • Example: Pain when it’s windy.

What Trigeminal Neuralgia Feels Like:

1. Type of Condition: Trigeminal neuralgia is a long-term condition affecting the main nerve in your face.

2. How the Pain Feels:

   • It comes in sudden, brief bursts of shooting or stabbing pain.

   • The pain is usually in the area controlled by one of the trigeminal nerve branches (forehead/eyes/nose, upper jaw, or lower jaw).

   • It most often affects the upper and lower jaw areas.

3. Describing the Pain:

   • The pain is often described as burning, like a knife, or like an electric shock.

   • It can happen in your lips, gums (upper or lower), forehead, or the side of your nose.

4. Facial Pain: The main symptom is severe pain in your face.

5. One Side Only: The pain usually only affects one side of your face at a time.

6. Muscle Spasms: It can cause involuntary twitching of your facial muscles.

7. Eye and Mouth Effects: It can cause your eye to suddenly close or your mouth to twitch. It used to be called “tic douloureux” because of these painful twitches.

8. Triggers: The pain can happen for no reason or be started by things like chewing, talking, or touching the affected side of your face.

9. Impact on Daily Life:

   • People might change how they eat, avoid washing their face, or cover their face to avoid pain.

   • They might avoid social situations because of the pain.

10. Coping: Some people sleep a lot to cope with the pain.

11. Risk of Suicide: The intense pain can disrupt life so much that there is a risk of suicide.

12. Unpredictable: The pain comes back unpredictably, happening more or less often and lasting different amounts of time. Episodes can come back after days, weeks, or months.

How Trigeminal Neuralgia Works

• Classical (Idiopathic) Form: The exact cause isn’t known, but research suggests it might be due to a blood vessel irritating the trigeminal nerve (Gasserian ganglion). Pressure from a blood vessel is a likely cause. It’s more common in women and people with multiple sclerosis.

• Symptomatic (Secondary) Form: There are known causes that affect the nerve, such as a blood vessel pressing on the trigeminal ganglion.

Other Conditions That Could Be Mistaken for It

1. Multiple sclerosis (MS)

2. Tumors near the brainstem

3. Problems in the nose and throat area

4. Dental problems

5. Shingles

6. Unstable angina (chest pain)

How Trigeminal Neuralgia is Treated

Medications:

1. Carbamazepine (Tegretol):

   • How it Works: It reduces how nerves send pain signals.

   • Dosage: Usually starts at 100mg.

   • How to Take: Take with meals to lessen side effects.

   • Monitoring and Side Effects: Doctors watch for side effects like nausea, dizziness, drowsiness, and a rare problem with blood cells. Long-term use requires checking for bone marrow issues.

2. Other Medications:

   • Gabapentin and baclofen can also help with pain.

   • If the pain isn’t well controlled, phenytoin (Dilantin) might be added.

Surgery:

1. Microvascular Decompression:

   • A surgery where the skull is opened to relieve pressure on the trigeminal nerve.

2. Percutaneous Radiofrequency:

   • A procedure that uses heat to create a small area of damage on the trigeminal nerve to block pain signals.

   • It can provide quick pain relief, but side effects can include numbness and loss of the blink reflex.

3. Gamma Knife Radiosurgery:

   • Uses focused radiation beams, guided by MRI, to target the trigeminal nerve.

4. Balloon Micro-Compression:

   • A procedure where a small balloon is used to press on the trigeminal nerve, disrupting the large fibers that transmit pain.

Helping Yourself (Nursing Management):

1. Identify Triggers:

   • Try to figure out what things make your pain worse (like hot or cold, or sudden movements).

   • Use things like cotton pads to wash your face and use lukewarm water.

2. Oral Hygiene:

   • If brushing your teeth hurts, rinse your mouth out after eating.

   • Try to do your personal care when you don’t have pain.

3. Diet:

   • Eat and drink things that are room temperature.

   • Chew on the side of your mouth that doesn’t hurt and eat soft foods.

4. Emotional Health:

   • Recognize and address feelings of anxiety, depression, and trouble sleeping, which are common with ongoing pain.

   • Get help and support if needed.

5. After Surgery Care:

   • Doctors will check your face muscles and feeling after surgery.

6. Eye Care:

   • If your face feels numb after surgery, be careful not to rub your eye.

   • Watch for redness or irritation and use artificial tears if your doctor prescribes them.

7. Eating and Swallowing:

   • Pay attention to any trouble you have eating or swallowing different types of food.

8. Support Groups:

   • Joining a support group can provide emotional support and information.

In General:

Trigeminal neuralgia is hard to cure completely. Treatment focuses on reducing pain with medications like antiseizure drugs (carbamazepine, phenytoin, clonazepam) and painkillers during painful episodes. If these don’t work, surgery might be an option.

Medical Management:

1. Medication:

   • Antiseizure drugs like carbamazepine, phenytoin, or clonazepam are used along with painkillers when you have pain.

2. Surgery:

   • If medications don’t help, surgical options include:

     • Injecting glycerol into the trigeminal nerve.

     • A surgery called suboccipital craniotomy rhizotomy to relieve pain.

     • Gamma knife radiosurgery.

     • Percutaneous radiofrequency procedures.

Assessing and Teaching Patients:

1. Pain Assessment:

   • Doctors will carefully ask about your pain to create the best treatment plan.

2. Patient Education:

   • You’ll be taught about the condition, what causes it, and how it can be treated.

   • It’s important to understand how to prevent things that could increase the risk of suicide due to the pain.

Patient Care:

1. Hygiene and Nutrition:

   • Keeping clean and eating well is important for your overall health.

2. Psychological Support:

   • Getting emotional support can help you feel more confident and cope with the condition.

Tests:

1. Diagnostic Investigations:

   • Make sure you get any ordered tests done, like CT scans, MRIs, and spinal fluid tests, to help guide your treatment.