Trigeminal
neuralgia is a distressing complaint in
which episodes of sudden intense pain occur
in the area of the nerve that provides sensation
in the face. This is the fifth, or trigeminal,
cranial nerve. Only one side of the face
is affected.
Trigeminal
neuralgia affects middle-aged and elderly
people almost exclusively, causing repeated
attacks over periods of several weeks. During
these periods, the person affected may be
constantly ‘on edge’ in anticipation of
the next stab of pain.
There is
a tendency for the periods of freedom between
series of attacks to become shorter with
time.
Symptoms
The nerve
discharges cause episodes of excruciating
stabbing pain in the cheek, lips, gums,
chin or tongue, lasting for only a few seconds
or, at the most, a minute or two. The severity
of the pain causes the muscles of the face
to wince, hence the earlier name of tic
douloureux (‘painful tic’).
A feature
of the condition is that it may be brought
on by touching a particular part of the
face or any other area supplied by the trigeminal
nerve, such as the lips, gums or tongue.
It may thus be triggered by chewing, swallowing
or even speaking.
Causes
The cause
of trigeminal neuralgia is uncertain and
treatment is difficult.
Treatment
The drug
carbamazepine is effective in reducing the
intensity of the pain in most cases, but
about 20 per cent of sufferers develop resistance
to the drug and some are unable to tolerate
a high enough dosage to relieve the pain.
When drug
treatment fails, an injection to destroy
the root of the nerve, or even surgical
cutting of the nerve, may be necessary.
These procedures cause permanent numbness
of one side of the face and complications
are common.
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Trigeminal Neuralgia
