Trigeminal Neuralgia, also known as tic douloureux, is a rare condition characterised by pain originating from the trigeminal nerve. The trigeminal nerve is one of the twelve nerves in the cranial nerve cluster. People suffering from Trigeminal Neuralgia experience intense and severe pain in their faces.
What Are the Cranial Nerves?
Your brain has twelve pairs of nerves called the cranial nerves that connect your brain to the rest of your body. Each nerve is named for the function it serves and has a number assigned to it based on where it is in the brain.
Some of the cranial nerves are in control of information between the brain and the sense organs, while others are in control of muscles. Some of the nerves are connected to internal organs like the heart and lungs and glands. They all serve a sensory or a motor purpose to make your body operate smoothly.
Where Is the Trigeminal Nerve?
The trigeminal nerve is the fifth of the twelve cranial nerves. This nerve is the largest of the twelve and has both sensory and motor functions that stem from a central cluster of nuclei. Your trigeminal nerve has three branches that are in charge of three different areas of your face: the ophthalmic, the maxillary, and the mandibular.
These three areas work together to create your facial expressions. The ophthalmic region contains your forehead, scalp, and upper eyelids; the maxillary region contains your cheeks, upper lip, and nasal cavity; and the mandibular region controls your ears, lower lips, jaw, teeth, and chin. In short, you can thank your trigeminal nerve for your beautiful smile.
What Is Trigeminal Neuralgia?
Trigeminal Neuralgia (TN) is a condition that causes a burning sensation or stabbing pain in one or all of the three areas your trigeminal nerve controls. It can be so severe that the person experiencing it can’t drink, eat, or make specific movements.
It is most frequently found in more women than men; and although it is more common in people over the age of 50, it can occur at any age. The bouts of pain caused by Trigeminal Neuralgia is extreme but not life-threatening.
Trigeminal Neuralgia pain can spread over the face and down the neck and may be triggered by many different things. Sometimes, all it takes is a breath of wind across the face.
A Trigeminal Neuralgia flare-up might start with numbness, followed by intermittent bursts of burning or aching pain lasting anywhere from a few seconds to several minutes. The pain can become more frequent until it is almost continuous.
A flare-up can last for a few weeks or months, followed by a period of no pain that can last for 12 months or more.
Although the pain is intense and debilitating, there are effective treatments available.
Type 1 Trigeminal Neuralgia
Type 1 Trigeminal Neuralgia (TN1) is the most common form of the condition. It leads to extreme and sporadic burning sensations that last anywhere from a few seconds to two minutes each episode. The attacks can lead to a repetitive cycle of facial pain and pain free periods that can continue over two hours.
Type 2 Trigeminal Neuralgia
Type 2 Trigeminal Neuralgia (TN2) is also known as Atypical Trigeminal Neuralgia. TN2 usually affects people with less facial pain but the pain is more continuous than in cases of TN1.
In some cases, people can experience TN1 and TN2 simultaneously when TN1 attacks occur on top of the constant TN2 pain.
Why Is It Nicknamed “The Suicide Disease?”
Trigeminal Neuralgia is arguably one of the worst chronic pain conditions that people can experience. It is called “the Suicide Disease” because of the intense pain patients feel when they suffer from this condition. The rates of suicide in patients with Trigeminal Neuralgia are high.
These patients generally also suffer from anxiety, depression, and/or sleep disorders. Often, the condition is misdiagnosed, which adds to the suffering of the patient.
The pain may be so bad (and continue over so long a period) that many people would rather commit suicide than suffer through it.
Why Does Trigeminal Neuralgia Happen?
There are several reasons why a person may suffer from Trigeminal Neuralgia.
If a blood vessel presses against one of the branches of the trigeminal nerve on its way down the brain stem, it can lead to the neuralgia.
As time goes by, the pulse of the blood vessel that rubs against the nerve can lead to the myelin sheath around the nerve being worn away. This leaves the nerve exposed and very sensitive. When that happens, the symptoms can be similar to the pain and problems caused by dental issues. As a result, dental solutions are explored, and the real problem remains undiagnosed.
Compression of the brainstem, where the cranial nerves originate, is one of the most common causes. This can be due to misalignment of the bones in the upper neck, C1 and C2.
Neuropathic facial pain can also be caused by serious injury to the face. These injuries could be caused by a stroke, by oral surgery, by sinus surgery, or traumatic impact to the face.
In rare cases, a tumour or Multiple Sclerosis can be the cause of trigeminal neuralgia.
What Causes Trigeminal Neuralgia ?
Trigeminal Neuralgia can be caused by the reasons mentioned above or because of age. When a person has this condition, it can be triggered by many different things.
Brushing teeth, shaving, touching the face or teeth, eating, talking, or even applying makeup can cause pain. Some people have experienced pain when the wind has blown on their faces. It is very rare that people experience symptoms while sleeping.
How Is Trigeminal Neuralgia Diagnosed?
When diagnosing Trigeminal Neuralgia, it’s necessary for the health professional to look at the patient’s medical history and health information before conducting a physical examination. All other potential causes for the facial pain need to be ruled out before an official diagnosis is made.
A series of tests and patient consultations will help the health professional determine the extent of the pain, how it feels, what triggers it, and what brings pain relief. Many people experiencing Trigeminal Neuralgia pain will have to undergo an MRI test to ensure that their symptoms aren’t being caused by a tumour or Multiple Sclerosis.
Additionally, specialized laboratory tests or imaging might be able to show if the issue is stemming from a blood vessel pressing on the trigeminal nerve.
TN1 can be diagnosed through a patient’s positive response to certain anti-seizure medication. TN2 is much harder to diagnose and can usually be confirmed with a positive response to low doses of tricyclic antidepressant medications (such as amitriptyline and nortriptyline).
What Are the Treatment Options for Trigeminal Neuralgia?
There is no straightforward method used to treat Trigeminal Neuralgia. Most over-the-counter pain medication does not work for this condition. However, seizure medicine such as gabapentin and carbamazepine might be helpful, especially for those who suffer from TN1. Those with TN2 may benefit from the use of certain antidepressants. A doctor will have to prescribe the correct dosages for the people suffering from Trigeminal Neuralgia’s attacks of pain.
Surgical procedures are an option that most people opt for because they can help bring the pain under control. But before considering surgery, a patient will need to seek medical advice from a specialist and may need to know the exact cause of their pain.
There are several kinds of rhizotomy options to relieve the neuropathic pain as well, and they can be performed under general anesthesia. A major side-effect of any rhizotomy to treat Trigeminal Neuralgia is facial numbness.
Balloon Compression is a procedure that is often used to treat TN. This method usually provides short-term relief and is done as an outpatient procedure. While the patient is under anesthesia, a small tube with a balloon attached to the tip is inserted through the cheek to rest against the nerve fibers in the face. The balloon is inflated for about a minute and then removed.
Stereotactic radiosurgery, also known as Gamma Knife radiosurgery, involves a precise and concentrated beam of radiation directed at the trigeminal nerve. This method serves to relieve the pain effectively.
Another surgery option is Microvascular Decompression (MVD). It can be a long-lasting or temporary solution, depending on your body. An incision behind the ear is made so a small piece of the skull can be removed so doctors gain access to the blood vessels and nerves. The surgeon will then place insulation around the vessel, so it doesn’t rub against or compress the nerve. While many patients may feel relief after Microvascular Decompression (MVD), the pain may return to one-third of the patients who undergo this surgery because the vessels grow back.
Radiofrequency Thermal Lesioning is another method used to relieve Trigeminal Neuralgia pain. For this type of surgery, a hollow needle is inserted through the cheek on the sides of the face where the pain occurs. A chemical or a light electric shock is then used to kill the pain fibres of the trigeminal nerve. The use of this electrical current can be repeated as many times as desired. As a result, pain symptoms are no longer felt for up to 4 years. However, extreme numbness in the face may occur on one side or the other.
People looking for a quick solution can apply heat or ice to the area affected by the pain to reduce the firing of pain signals. A cold compress or hot water bottle can help out if the pain gets terrible.
The National Institute of Neurological Disorders and Stroke, the United State government’s leading supporter of biomedical research on neurological disorders, is conducting more research to learn more about the causes and treatments of TN1 and TN2.
How Can Chiropractic Help Trigeminal Neuralgia ?
Trigeminal Neuralgia is associated with nerve problems, so a chiropractor may be able help decrease the pain and symptoms long term. Chiropractic care is focused on the nervous system and spine, and Trigeminal Neuralgia can be managed holistically through upper-cervical adjustments. A chiropractor will make an adjustment that may be able to ease the nerve causing the pain signals. The pain may not subside immediately and may take multiple adjustments before the patient begins to feel long-term relief, but this is usually more effective long term than medication. You can ask your primary care doctor’s medical advice if you believe chiropractic care may be a good route for your care.
Trigeminal Neuralgia is a horrible and debilitating condition that no one should have to endure. Fortunately, adjustments from chiropractic care to surgery are available to make a patient’s life more bearable and reduce the pain for good at a reasonable price. Here at Vitality Chiropractic, we offer upper-cervical adjustments that will help you improve your suffering from chronic neurological conditions, such as Trigeminal Neuralgia.
Call 8438 9550, email email@example.com, or complete our contact form below to get a consultation from our chiropractic Singapore clinic.
A Brief Trigeminal Neuralgia Fact Sheet:
Before we wrap up this article on Trigeminal Neuralgia, let’s do a quick review of the condition.
- It’s a condition that affects more women than men
- The condition comes from interference of some kind with the trigeminal nerve
- Trigeminal Neuralgia affects the top, bottom, and/or side of the face
- Trigeminal Neuralgia can affect both sides or one side of the face
- The condition produces attacks of pain that include an aching/burning sensation in the facial nerves
- Impaction from blood vessels or outlying forces usually damage the nerve, leading to face pain
- Pain relief from Trigeminal Neuralgia is possible through surgery or some holistic options like chiropractic care, even though it may lead to facial numbness
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Shaan Rai (Chiropractic, Singapore)
Shaan (UK) is based in Singapore. He is a GCC registered Singapore Chiropractor, completing a 5 year course at AECC, attaining his Masters in Chiropractic. His career has been specialised in neurological cases, such as migraines and vertigo. He is the Chairman for Outreach and Charity for Alliance of Chiropractic (AoC) and is a founder of Vitality Chiropractic Singapore and the NeuroPro method, combining Upper Cervical techniques with Functional Neurology Rehab.