
Trigeminal neuralgia (TN) is a chronic pain disorder that causes episodes of intense facial pain. TN is typically caused by damage or irritation to the trigeminal nerve, which can be due to various factors such as pressure from blood vessels, tumours, or trauma. On the other hand, a stroke occurs when blood flow to the brain is interrupted, potentially damaging the brain tissue. While TN and stroke can have similar presentations, such as facial pain, there are distinct features that can help differentiate between the two conditions. TN typically presents as intense, sharp, or electric shock-like pain in the face, often triggered by activities that involve touching or moving the face. Stroke, on the other hand, can cause a range of symptoms, including sudden numbness or weakness in the face, arm, or leg, difficulty speaking or understanding speech, sudden severe headache, and vision problems.
Characteristics | Values |
---|---|
Main Cause | Pressure on or damage to the trigeminal nerve |
Type of Pain | Intense, sudden, electric shock-like, stabbing, burning |
Pain Location | Face, lips, eyes, nose, scalp, forehead, jaw |
Pain Duration | Seconds to 2 minutes |
Pain Frequency | Sporadic to constant |
Pain Intensity | Painful enough to cause facial wincing |
Pain Triggers | Shaving, washing face, eating, drinking, brushing teeth, talking, smiling, applying pressure to face |
Pain Treatments | Medication, surgery, acupuncture, psychotherapy |
Risk Factors | High blood pressure, biological family history of TN, female sex |
Diagnosis | MRI, neurological exam, physical exam |
What You'll Learn
Trigeminal neuralgia symptoms
Trigeminal neuralgia (TN) is a chronic pain disorder that causes episodes of intense facial pain. TN is not life-threatening, but it can be life-altering. It is characterised by sudden, sharp, shooting pain that feels like an electric shock. The pain usually occurs on one side of the face, but in some cases, it can affect both sides. The pain can be felt in the teeth, lower jaw, upper jaw, cheek, forehead, or eye.
Between pain attacks, individuals with TN may experience a constant throbbing, aching, or burning sensation. They may also experience regular episodes of pain for days, weeks, or months, followed by periods of remission where the pain disappears for several months or years. In severe cases, TN attacks can occur hundreds of times a day without any periods of remission.
TN attacks can be triggered by certain actions or movements, such as shaving, putting on makeup, or eating and drinking. Even a cool breeze or vibrations from walking or travelling in a car can trigger an attack. However, the pain can also occur spontaneously without any apparent trigger.
The condition is caused by pressure on or damage to the trigeminal nerve, which is the largest of the cranial nerves. The trigeminal nerve has three branches: ophthalmic, maxillary, and mandibular, and it provides sensory and motor information to different parts of the head and face.
TN is typically classified as primary (classic), secondary, or idiopathic, depending on the underlying cause. Primary TN is the most common type and occurs when a blood vessel, usually the superior cerebellar artery, pushes against the trigeminal nerve root. Secondary TN is caused by another condition, such as multiple sclerosis, a tumour, or arteriovenous malformation, damaging the trigeminal nerve. Idiopathic TN is diagnosed when there is no clear cause of facial pain after diagnostic tests.
Living with TN can be extremely challenging, and individuals may experience a significant decrease in their quality of life. They may avoid activities such as washing, shaving, or eating to prevent triggering the pain, and the fear of pain may lead to social isolation. Additionally, the emotional strain of living with repeated episodes of pain can result in psychological problems, including depression.
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Trigeminal nerve functions
The trigeminal nerve is the fifth cranial nerve, or CN V, and is the largest of the 12 cranial nerves. It is a mixed nerve, with both sensory and motor functions. The trigeminal nerve is made up of three branches: the ophthalmic (V1) nerve, the maxillary (V2) nerve, and the mandibular (V3) nerve.
The ophthalmic nerve branch provides sensory information for the face and skull in the opening between the eyelids of each eye (palpebral fissure). It also supplies sensation to parts of the nasal cavity. This branch includes sympathetic nerve fibres that play a role in dilating the pupils and supplying sensation to the eyes.
The maxillary nerve branch provides sensory information for the maxillary teeth (teeth in the upper jaw), the middle portion of the face and skull (the area below the eyes and above the mouth), and parts of the nasal cavity and sinuses.
The mandibular nerve branch is the largest of the three and has both sensory and motor fibres. It provides sensory information for the inner lining of the cheeks (buccal mucosa), the floor of the mouth, the mandibular teeth (teeth in the lower jaw), the skin below the mouth, and the outer part of the ear. The motor portion of this branch provides movement information to the muscles involved in chewing (mastication) and plays a role in swallowing by supporting the digastric and mylohyoid muscles.
The trigeminal nerve helps the face recognise pain, touch, heat, and cold sensations. It also enables the movement of the jaw muscles.
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Trigeminal nerve damage causes
The trigeminal nerve is a large, three-part nerve in the head that sends signals from the brain to the face and vice versa. There are two trigeminal nerves, one on each side of the face. Trigeminal nerve damage can be caused by a variety of factors, including:
Head Trauma or Brain Conditions
Injuries to the head or brain conditions can damage the trigeminal nerve. This includes physical trauma, such as a blow to the head, or brain conditions such as tumours or multiple sclerosis.
Pressure from Nearby Structures
The trigeminal nerve can be compressed by nearby structures, including blood vessels, tumours, or swelling. This compression can disrupt the nerve's function and cause damage.
Inflammation from Infections
Certain infections, such as the herpes zoster virus (shingles), can cause inflammation and damage to the trigeminal nerve.
Circulatory Issues
Problems with blood flow, such as microvascular disease, can affect the trigeminal nerve. This can include conditions that affect the blood vessels supplying the nerve or the brain.
Autoimmune Conditions
Autoimmune conditions such as scleroderma and Sjögren’s syndrome can damage the trigeminal nerve. These conditions cause the body's immune system to attack healthy tissues, including nerves.
Accidental Damage from Surgery
In rare cases, brain, facial, or dental surgery can accidentally damage the trigeminal nerve. This can occur when the surgery is performed near the nerve, and it can result in temporary or permanent nerve damage.
It is important to note that the causes of trigeminal nerve damage can vary, and in some cases, there may be no clear cause even after diagnostic tests. Trigeminal nerve damage can lead to a range of symptoms, including facial numbness, tingling, muscle spasms, and difficulty with chewing, speaking, or swallowing.
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Trigeminal nerve damage symptoms
Trigeminal nerve damage can cause a range of symptoms due to its large size and various functions. The trigeminal nerve is responsible for sending and receiving motor (movement) and sensory information to and from different aspects of your head and face. As such, damage to the nerve can cause issues such as:
- Facial numbness or tingling
- Jaw muscle spasms or weakness
- Difficulty chewing, speaking or swallowing
Trigeminal nerve damage can also cause trigeminal neuralgia (TN), a chronic pain disorder that causes episodes of intense facial pain. TN is characterised by sudden, sharp, intense pain, often described as a shock-like or stabbing pain, usually on one side of the face. This pain can be triggered by everyday activities such as shaving, eating, drinking, brushing teeth, applying makeup, talking, or being exposed to wind or a breeze. In between attacks, a person may experience a burning, throbbing, numbness, tingling, or dull aching sensation.
TN is typically caused by pressure on or damage to the trigeminal nerve, often from a blood vessel pressing on the nerve. It is important to note that trigeminal nerve damage can also be caused by a stroke, specifically a lateral medullary infarction, which results in damage to the trigeminal tract.
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Trigeminal nerve damage treatment
Trigeminal neuralgia (TN) is a chronic pain disorder that causes episodes of intense facial pain. TN is not life-threatening, but it can be life-altering. It can make simple activities such as chewing, talking, smiling, and brushing teeth difficult due to the pain. TN is typically a long-term condition, but several treatments can help manage symptoms.
TN is usually caused by pressure on or damage to the trigeminal nerve, which is the largest of the cranial nerves. The trigeminal nerve has three branches: ophthalmic (V1), maxillary (V2), and mandibular (V3). It provides motor (movement) and sensory information for different aspects of the head and face.
Healthcare providers categorize TN into three types based on the specific cause:
- Primary (classic) TN: This is the most common type and occurs when a blood vessel, usually the superior cerebellar artery, pushes on the trigeminal nerve root.
- Secondary TN: This happens when another condition, such as multiple sclerosis (MS), a tumor, or arteriovenous malformation, damages or affects the trigeminal nerve.
- Idiopathic TN: This is diagnosed when there is no clear cause of facial pain after diagnostic tests.
TN treatment options range from medications to surgical procedures. The specific treatment plan will depend on the type of TN and the patient's individual needs. Here is an overview of the treatment options:
Medications
Medications are often the first line of treatment for primary and idiopathic TN. Antiseizure medications, such as carbamazepine, oxcarbazepine, gabapentin, pregabalin, and lamotrigine, are commonly used to block pain signals. Baclofen, a muscle relaxant, is another option. It is important to note that medications may lose their effectiveness over time, and patients should work closely with their healthcare provider to manage their symptoms.
Surgery
Surgery is typically considered if medications are ineffective or if the patient has secondary TN, such as a tumor pressing on the nerve. Various surgical procedures are available, including:
- Microvascular decompression: This is the most invasive surgery but also the most effective at preventing long-term pain. It involves relieving pressure from blood vessels pressing against the trigeminal nerve.
- Radiosurgery: This procedure focuses radiation on the root of the trigeminal nerve to block pain signals.
- Rhizotomy: This procedure intentionally damages the root of the trigeminal nerve to block pain signals and can result in facial sensory loss and numbness.
- Peripheral neurectomy: This procedure involves damaging or removing a peripheral branch of the trigeminal nerve through alcohol injection, incision, cryotherapy, or radiofrequency lesioning.
Other treatments
In addition to medications and surgery, other treatments can be used in combination with medication for pain management:
- Botulinum toxin injections or nerve blocks: These provide temporary pain relief.
- Psychotherapy: Talking to a mental health professional can help manage the emotional impact of TN.
It is important to note that TN treatment may require a trial-and-error approach to find the most effective approach for each patient. Additionally, maintaining a healthy lifestyle, including a nutritious diet, stress management, and maintaining a healthy weight, can also support nerve health and overall well-being.
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Frequently asked questions
Trigeminal nerve damage and a stroke can have similar symptoms, including facial numbness or tingling, and difficulty chewing, speaking or swallowing. However, trigeminal nerve damage is typically caused by head trauma, brain conditions, pressure from nearby blood vessels, tumours, or swelling, whereas a stroke is caused by a blockage or rupture of a blood vessel in the brain.
The trigeminal nerve is a large, three-part nerve in your head that sends signals from your brain to your face and vice versa. There are two trigeminal nerves, one on each side of your face. They provide sensory and motor information to different aspects of your head and face, including touch sensations, pain recognition, and temperature.
Trigeminal neuralgia is a chronic pain disorder that causes intense pain attacks in your face. It happens when your trigeminal nerve is damaged or irritated, often by a blood vessel pressing on the nerve near the brainstem.
The main symptom is sudden, intense pain in your face, usually on one side. The pain may feel like an electric shock and can be triggered by activities such as shaving, putting on makeup, or washing your face.
Trigeminal neuralgia can be treated with medication or surgery. Antiseizure medications are often the first line of treatment, as they can block pain signals. If medication is ineffective, surgery may be considered to relieve pressure from blood vessels or to intentionally damage the nerve to block pain signals.