Trigeminal Neuropathy: Everything You Need to Know

Trigeminal neuropathy is a chronic disorder that can cause sudden, acute pain episodes on one side of your face, disrupting regular tasks. Surgical methods often only reduce symptoms for a limited time, but various types of medication can assist in easing these brief, random, and excruciatingly painful episodes.

What is Trigeminal Neuropathy?

Extreme face pain that might interfere with daily life is the hallmark of trigeminal neuropathy, also known as tic douloureaux. Daily actions like eating, talking, smiling, tooth brushing, and shaving might bring sharp, temporary discomfort. These bouts of pain are usually brief, but they can occasionally return (on and off). On the other hand, you could have persistent pain that is less severe.

Trigeminal neuropathy usually affects one side of the face (meaning it only affects one side of your face). Both sides will feel the effects if it's bilateral, though not necessarily at the same time. Even more uncommon is having trigeminal neuropathy on both sides. Interestingly, this ailment typically affects the right side of the face more than the left.

What is the Trigeminal Nerve?

One of the dozen pairs of nerves connected to your brain is called the trigeminal nerve. It's in charge of relaying information about pressure and temperature from your face and head to your brain. The trigeminal nerve has three divisions, each of which sends signals to a separate area of the face:

  • The ophthalmic branch. Your skull and the area of your face above your ears.
  • The maxillary branch. Your top lip, nose, and cheeks make up the central features of your face.
  • The mandibular branch. Part of your face includes your bottom lip and jaw.

Types of Trigeminal Neuropathy

The most common types of trigeminal neuropathy are:

Typical (Type 1) Trigeminal Neuropathy:

Painful episodes are likely to be short, severe, and infrequent. The pain and burning sensation could spread across your entire face and last a few seconds to two minutes. Up to two hours of this can occur, with pain-free intervals in between.

Atypical (Type 2) Trigeminal Neuropathy:

This will have a broader impact with less pain and intensity. You'll probably be in a lot of pain all the time, especially if you're sensitive to heat or cold. Your ability to manage your symptoms may be diminished if you have atypical trigeminal neuropathy.

How Common is Trigeminal Neuropathy?

Trigeminal neuropathy affects around 150,000 people per year. A rate of 4.3 new cases per 100,000 individuals is approximated. People over 50 have a far higher incidence of developing trigeminal neuropathy than those under the age of 40, where it is incredibly uncommon. This is another rare illness that disproportionately affects females.

Is Trigeminal Neuropathy Related to MS?

Trigeminal neuropathy affects around 1% to 2% of patients with MS. There is some overlap between multiple sclerosis and trigeminal neuropathy because both conditions involve the gradual breakdown of the myelin sheath, the primary protective layer around the nerve. Trigeminal neuropathy can also appear in MS patients. In a similar vein, people with trigeminal neuropathy who are 40 or younger are at increased risk for developing multiple sclerosis. If you're in this age range, it's crucial to think about getting tested for multiple sclerosis.

What Causes Trigeminal Neuropathy?

Various factors can bring on trigeminal neuropathy, but the most common cause is pressure from a blood artery on a nerve in the brain stem. People with MS are more likely to acquire TN because the disease damages the protective myelin layer surrounding nerve fibers.

A tumor or lesion that presses on nerves can also produce this syndrome; however, this is far less common. Trigeminal neuropathy-like facial nerve pain can occur if the trigeminal nerve is damaged during oral or sinus surgery, following a stroke, or due to trauma to the face.

The pain of trigeminal neuropathy might be idiopathic in some people, meaning the cause has not been determined.

What are the Symptoms of Trigeminal Neuropathy?

Certain symptoms are limited to the face and jaw area, such as:

  • Numbness or tingling are common symptoms.
  • Short bouts of excruciating pain.
  • Aches and pains are common.

Other signs and symptoms include:

  • Short-term pain jolts, a stabbing or electrifying sensation.
  • Out-of-the-blue episodes are triggered by ordinary activities such as eating or conversing.
  • A burning sensation on one side of your face.

Which Activities Most Commonly Trigger Trigeminal Neuropathy?

The majority of painful episodes are caused by basic tasks that require you to move or touch your face, such as:

  • Any reason you touch your face (shaving, putting on makeup, washing your face).
  • Consuming food and beverages.
  • Brushing your teeth, flossing, and using mouthwash are all essential steps.
  • Smiling and talking.
  • Any impact or pressure applied to your face, particularly your cheek or jawline.
  • When there is a strong wind or a breeze in your face.

How is Trigeminal Neuralgia Treated?

Medications, surgery, and alternative treatments are all options for relieving the pain of trigeminal neuralgia.

  • Tricyclic antidepressants: The most prevalent drugs in this class, which are used to treat symptoms of Type 2 trigeminal neuralgia, are amitriptyline and nortriptyline.
  • Anticonvulsant drugs: In most cases, carbamazepine is the drug of choice for relieving the discomfort of trigeminal neuralgia. Oxcarbazepine, phenytoin, lamotrigine, sodium valproate, gabapentin, clonazepam, and topiramate are all anticonvulsant medications your doctor might recommend. If you've been taking one of these medicines and don't think it's doing the job, you can ask your doctor to up the dosage or prescribe something else. However, some undesirable symptoms are associated with anticonvulsant medications, such as lightheadedness, nausea, disorientation, and drowsiness, despite their usefulness in reducing pain.
  • Muscle relaxants: The use of baclofen is optional; it can be used with carbamazepine or phenytoin.
  • Other medications: It is possible to prevent sensation by injecting botulinum toxin. Nerve blocks are sometimes employed as a short-term solution.

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