Tic douloureux

Definition

Trigeminal neuralgia is an extremely painful inflammation of the largest nerve in the skull (trigeminal nerve).

Alternative Names

Causes

Trigeminal neuralgia causes severe lightening-like facial pain on the side of the affected nerve. The condition usually affects older adults. Often, no cause can be found, although areas of brain inflammation or abnormal blood vessels (arteriovenous malformations) can be responsible.

Painful trigeminal neuralgia attacks may occur after lightly touching different skin areas of the face, along the course of the sixth cranial (skull) nerve.

Symptoms

• Very painful, sharp electric-like spasms last a few seconds to minutes
• Pain is triggered by touch or sounds
• Pain during chewing, eating, drinking, shaving, or brushing teeth

Exams and Tests

An MRI and blood tests may help rule out other conditions.

Treatment

Certain medicines can help reduce pain and the rate of attacks. Medicines may include:

• Anti-epilepsy drugs
• Migraine medicines (sumatriptan)
• Tricyclic antidepressants such as amitriptyline, nortriptyline, or carbamazepine

Some patients may require surgery. 

Kanai A, Saito M, Hoka S. Subcutaneous sumatriptan for refractory trigeminal neuralgia. Headache. 2006 Apr;46(4):577-82.

Goetz, CG. Textbook of Clinical Neurology. 2nd ed. St. Louis, Mo: WB Saunders; 2003: 178-179.