Trigeminal Neuralgia Symptoms – Do I have TN?
Great question. Basically, trigeminal neuralgia (TN) is an excruciating facial pain condition that affects one side of the face and comes in short bursts and can completely knock a person off their feet, literally. Type I and II trigeminal neuralgia are called “idiopatic”, meaning there’s no other reason for the pain such as a benign tumor pressing on the nerve of a previous direct injury to the nerve itself.
Type I and Type II Trigeminal Neuralgia
Trigeminal neuralgia comes in two types; Type I TN is also called “classic” trigeminal neuralgia.
In Type I TN, people describe their pain using words like “electrical”, “stabbing”, “sharp”, “shock-like”. Patients also start to realize that certain things can trigger their pain. Basic things like talking, chewing, touching a certain part of their face, or brushing their teeth, can set off a pain episode. Oftentimes, people can point to a specific area of the face that they absolutely will not touch because this area will always set off a painful episode. As a result, people tend to avoid these pain “triggers”.
Type II TN is a little bit different. Here, people describe the same “stabbing” or “electric shock” sensations on one side of the face, but they also have a more constant component to their story. Type II TN patients describe a “throbbing”, “burning sensation”, or even a sensation of “numbness” on the same side of the face where they experience the more classic “stabbing” pains. Type II TN patients can also have triggers that they avoid to try and prevent a painful episode and control the pain.
“Secondary” Trigeminal Neuralgia
If a person has a tumor or a vascular malformation pressing on or digging into the nerve, then the pain is considered “secondary” TN – meaning another lesion is the true cause of the pain. In patients with TN and a diagnosis of multiple sclerosis, the pain is often considered “secondary” to MS. In many cases, the pain a person feels is exactly the same as type I TN, meaning they feel the same “shocks” or “electrical” pain signals. People can even have similar “triggers” for the pain, such as brushing their teeth or eating. The only difference is the presumed cause of the painful condition.
Facial pain – What causes trigeminal neuralgia pain?
Trigeminal neuralgia is also called “tic douloureux”. This was the French name given to one-sided facial pain by Nicholas André in 1756 when he noticed that facial pain patients would contract one side of the face every time they had a severe pain episode, almost having a muscle spasm of one side of the face.
The Trigeminal Nerve – Just think of a Tree with 3 big branches
To begin to understand facial pain, you need to understand that we have 2 trigeminal nerves (1 of 12 pairs of cranial nerves); one trigeminal nerve feels the right side of the face and one feels the left side of the face. The trigeminal nerves are like trees in that they have a “trunk” and three larger “branches”. Each branch feels a part of the face (these divisions are called V1, V2 and V3).
Inside the nerve are hundreds of nerve fibers. You can think of each tiny nerve fiber as a “wire” that carries information from the face to the brain to tell us what is happening with our skin, eyes, teeth, etc.. Each sensory wire carries a different kind of sensation. For example, there is a set of wires that feel hot and cold, and another set of wires that feel sharp pin-pricks and yet another set that feels pressure on our teeth.
These wires are all bundled together like the cable in your home and are meant to send the correct pain signals to your brain. Like most electrical wires, they are surrounded by insulation (myelin). The myelin insulation keeps the sensory information flowing quickly to the brain while preventing the wires from “shorting out” on each other by mistake.
Inside the nerve are hundreds of nerve fibers. You can think of each tiny nerve fiber as a “wire” that carries information from the face to the brain to tell us what is happening with our skin, eyes, teeth, etc.. Each sensory wire carries a different kind of sensation. For example, there is a set of wires that feel hot and cold, and another set of wires that feel sharp pin-pricks and yet another set that feels pressure on our teeth.
These wires are all bundled together like the cable in your home and are meant to send the correct pain signals to your brain. Like most electrical wires, they are surrounded by insulation (myelin). The myelin insulation keeps the sensory information flowing quickly to the brain while preventing the wires from “shorting out” on each other by mistake.
Facial Pain – When the System Goes “Haywire”
When someone experiences “electrical shocks”, “stabbing pain” and “sharp pain” that come in short bursts (1-3 seconds) and are triggered by eating, talking, chewing, or touching their face, trigeminal neuralgia is likely.
We believe that the wires inside the trigeminal nerve “tree” are starting to “short out” on each other. When a wire that feels cold water on your face shorts out on a wire that is meant to feel sharp pain, the cold water makes the pain wire fire by mistake. This is called “ephaptic transmission”. This happens when the insulation between two different sensory wires breaks down in small spots. When this happens, erroneous pain signals are sent to your brain in short bursts by mistake.
The breakdown of the insulation is often the result of a blood vessel pressing on and heating up the trigeminal nerve at its “trunk”. This pressure can damage the nerve over time, causing facial pain. This situation is called “neurovascular conflict” and is often found in patients with type I (classic) trigeminal neuralgia symptoms. The breakdown of the myelin sheath (insulation) can also be seen in patients with multiple sclerosis (MS).
MS is a condition where the myelin sheath tends to breakdown in specific locations and in this case, the myelin breaks down along the trigeminal nerve pathway. As time progresses, the breakdown of insulation can become more severe and episodes of pain that used to be short and rare become more frequent and intense. Some patients can progress to type II (atypical) trigeminal neuralgia as their condition goes further along.
Incidence and Treatment Options – Trigeminal Neuralgia
According to the National Institute of Neurological Disorders and Stroke (NINDS), “The incidence of new TN cases is approximately 12 per 100,000 people per year.” Trigeminal neuralgia also occurs more commonly in women than in men. In the United States, “the annual incidence (age adjusted to the 1980 age distribution of the United States) is 5.9 per 100,000 women and 3.4 per 100,000 men.”1
There are a variety of treatment options for trigeminal neuralgia and facial pain.
All of them start by making the right diagnosis first! Once the diagnosis of trigeminal neuralgia has been made by an experienced expert, treatment options striving to result in pain relief most commonly include:
Medications (such as Trileptal, Tegretol, Gabapentin, Baclofen, etc)
- Microvascular Decompression Surgery (MVD)
- Gamma Knife Radiosurgery
- Percutaneous Rhizotomy
- Pain Stimulators
Alternative therapies (Botox, Acupuncture, Mindfulness)