Written by Akshara Koneru
Edited by Anirudh Koneru
Published on 8/19/2020
Trigeminal Neuralgia is a rare condition that affects the nerves, resulting in sharp, shocking pains, typically on only one side of the face. These attacks of pain can last from just a few seconds to multiple minutes. The pain is classified into two types; Type 1 (or TN1) are severe, acute pains in the mouth, cheek, nose, etc. while type 2 (TN2) is a burning or throbbing pain that remains constant. It is possible for both to occur at the same time. The pain is suspected to be caused by blood vessels (or possibly a tumor) pushing against the trigeminal nerve (the nerve that conveys feelings and sensations from the brain to the skin of the face). Another cause may be multiple sclerosis, another nerve disorder in which the nerve coverings are destroyed. Trigeminal neuralgia is most likely to be found in those above the age of 50 and is more common in women than men.
Signs and Symptoms
The most telling sign of this disease are the episodes of sharp pains often compared to feeling electrical shock. Possible triggers for this include simple activities such as speaking or brushing your teeth, but pain attacks may be spontaneous as well. The pain is most commonly in the cheeks, jaws, teeth, and lips, and less often found in the eyes and the forehead. Additionally, the pain is almost always on only one side of the face.
Over time, episodes of pain become more and more frequent, and the periods of painless time between attacks decrease. Throbbing pain may remain for several minutes after an attack, and decrease completely before the next. Depending on the individual, the amount of attacks may vary from only being occasional to having up to a hundred per day. Episodes usually do not occur when asleep. The effects of pain attacks are flushed faces (only on one side), tearing up of the eye, excessive salivation, as well as depression and anxiety. Many people avoid triggering activities that may cause pain, such as applying makeup or even washing your face.
Etiology
Unfortunately, the cause behind trigeminal neuralgia is not yet known. It is understood that TN is the result of a blood vessel pressing on the trigeminal nerve located close to the base of the brain, causing sudden pains. However, the reason as to why this occurs is still unexplained. Some scientists and researchers believe that the attacks of pain are caused by the damage to the myelin sheath (protective layer over nerves) on certain nerve fibers. Another suspected cause is multiple sclerosis. TN can also be an effect of aging, injuries caused by surgery, or stroke.
Diagnosis
There is no specific test to determine whether or not a patient has trigeminal neuralgia, so doctors have to mainly rely on the patient’s medical history and the description of their symptoms. The pain is described by the type that is experienced and how it feels, where it occurs, and what triggers it. Neurological assessments, in which the doctor touches parts of the face to understand where the pain is happening and what part of the trigeminal nerve are influenced, as well as reflex tests, may be done to understand the cause, whether it be pressure against the nerve or something else. Additionally, MRI (magnetic resonance imaging) scans are often done to understand if it is a tumor or multiple sclerosis that is the cause. Dyes may be added to the blood vessels to see what arteries or veins are affected and to more clearly view the path of blood flow.
Rarity
Trigeminal neuralgia is a very rare condition. On a yearly basis, the likelihood of a new case is around 12 per every 100,00 people.
Resources
There is a wide variety of organizations and support groups available to help patients and caretakers who struggle with trigeminal neuralgia as well as informative sites for those looking to be educated.
Some organizations with resources for those affected by trigeminal neuralgia:
The Facial Pain Association (contact information found at https://fpa-support.org/)
Trigeminal Neuralgia Association UK (https://www.tna.org.uk)
The Living With Facial Pain (https://www.livingwithfacialpain.org/)
For those personally affected by this disease, the following online support groups may be helpful as a way to cope and find a community:
A great website for clinical trials on rare diseases all around the world is https://clinicaltrials.gov/. If you are looking for clinical testing opportunities specifically for trigeminal neuralgia, the following link provides many studies that are looking to recruit patients: https://www.clinicaltrials.gov/ct2/results?cond=%22Trigeminal+neuralgia%22&Search=Apply&recrs=a&age_v=&gndr=&type=&rslt=.
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Citations
Cohen, J., & NORD. (2016, May 18). Trigeminal Neuralgia. Retrieved August 17, 2020, from https://rarediseases.org/rare-diseases/trigeminal-neuralgia/
Mayo Clinic Staff. (2017, July 26). Trigeminal neuralgia. Retrieved August 17, 2020, from https://www.mayoclinic.org/diseases-conditions/trigeminal-neuralgia/symptoms-causes/syc-20353344
Trigeminal Neuralgia Fact Sheet. (2020, March 17). Retrieved August 18, 2020, from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Trigeminal-Neuralgia-Fact-Sheet
Trigeminal neuralgia. (2016, February 17). Retrieved August 17, 2020, from https://rarediseases.info.nih.gov/diseases/7805/trigeminal-neuralgia
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