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What is TN?

Trigeminal neuralgia (also called Tic Douloureaux) is believed to be the most painful condition known to medicine. The pain caused by TN has earned this condition the nickname “the suicide disease”. Opiates have little to no effect on the pain, but it can be managed with other medications and surgery. Attacks of pain can be triggered by vibration or contact with the cheek (such as when applying makeup, shaving, or washing the face), eating, drinking, talking, smiling, being exposed to wind, high pitched sounds or loud noises, or brushing the teeth. The pain can also occur sporadically with no trigger. While the condition is debilitating, it is not fatal. Some patients may avoid certain activities due to fear of trigger an attack (most noticeably in males that intentionally miss a spot while shaving).

The nerve affected in trigeminal neuralgia is the trigeminal nerve. This nerve divides into three branches, each serving a different area of the face. The ophthalmic branch provides sensation for the forehead, most of the scalp, and front of the head. The maxillary branch serves the cheek, upper lip, upper teeth and gums, upper jaw, and side of the nose. The mandibular branch serves the lower jaw, lower teeth and gums, and bottom lip. TN can affect one, two, or all branches of the trigeminal nerve.

The pain caused by trigeminal neuralgia can be caused by blood vessels or tumours pressing on the nerve. It can also be caused by the insulation of the nerve being stripped away by conditions like multiple sclerosis. In some cases there is no known cause.

The pain experienced by TN patients is described as an intense burning, electrical shock-like, crushing, or exploding pain. The pain usually occurs in one side of the face, though in some cases it can occur in both sides of the face at once. Some patients experience an aura before an attack begins; this may be a burning sensation or feeling of pressure on the face, tingling, numbness, or a constant ache that can begin days or minutes before an attack. Shocks of pain can last for a few seconds to a few minutes, often in rapid succession. These attacks can last for days at a time and can become permanent. Attacks rarely occur at night when the patient is asleep, even if their trigger area is in contact with a pillow.

TN attacks can go into remission, a period ranging from months to years without attacks. Generally TN worsens over time, with remission periods becoming shorter and shorter.

It is estimated that about 1 out of 15,000 people are affected by this disorder. It is often treated with anticonvulsants (carbamazepine being the most effective). Surgical treatments range from microvascular decompression (if caused by pressure from blood vessels) to destruction of the trigeminal nerve (which results in permanent numbness in the face).

 

Sources:

Trigeminal Neuralgia Association of Canada

Trigeminal Neuralgia Clinic, Mumbai India

National Institute of Neurological Disorders and Stroke

University of Manitoba

Personal experience

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