Trigeminal Neuralgia Specialists in New Jersey
he pain experienced by patients who suffer from trigeminal neuralgia (TN) is ranked as the most unbearable pain for a human being. With TN, simple routine activities like chewing, brushing teeth, or shaving may trigger the pain. The team of specialists at Centers for Neurosurgery, Spine, and Orthopedics can help alleviate the pain and reduce its frequency.
What is Trigeminal Neuralgia?
Trigeminal neuralgia (TN) is a painful condition that causes sudden, stabbing, electric shock-like excruciating pain in the facial area. In most cases, the unbearable pain is experienced during a period of seconds or up to two minutes. The pain is caused by the irritation of the trigeminal nerve on one side of the face or the other. It affects only the same side of the lower face and jaw, although sometimes it feels like the entire face is in pain.
The Trigeminal Nerve
The Trigeminal nerve is one of the twelve cranial nerves in the head. There is one trigeminal nerve on each side of the face. The trigeminal nerve mainly provides sensation to the face. Compression or irritation to either one of the trigeminal nerves is the cause of the excruciating pain on the same side of the lower face. There are two types of trigeminal neuralgia, primary and secondary trigeminal neuralgia.
Primary TN is the most common, causing about 95% of all trigeminal neuralgia cases. In primary TN, an artery or vein compresses the trigeminal nerves. The compression may cause irritation to the nerve, leading to TN pain. However, compression of the nerve may not fully explain the cause of TN, because there are people whose trigeminal nerve appears compressed on imaging but who do not suffer from excruciating pain. Irritation of the nerve also does not fully reveal the cause of TN, since some patients experience days of sporadic pain followed by periods of remission.
Secondary trigeminal neuralgia, on the other hand, is caused by factors other than the compression of the trigeminal nerve by an artery or vein. Such causes include infections or other external factors. Some medical conditions that may cause TN include multiple sclerosis (MS), tumors within the skull, arteriovenous malformation, or cysts. Other external factors include face or head injury, surgical procedures, or dental procedures.
Symptoms of Trigeminal Neuralgia
Pain in the facial area is the most common symptom of Trigeminal neuralgia. Some of the activities that may trigger TN pain include chewing, talking, smiling, brushing teeth, shaving, wearing makeup, kissing, facial touch, washing the face, or head movements. It is important to pay heed to how the pain manifests and from where it origins on the face in order to differentiate it from a headache or a toothache.
TN pain is classified as either TN1 or TN2. TN1 is described as an intense throbbing or stabbing pain that affects the lower face or any part of the facial area. TN2, on the other hand, is less intense with a constant, aching, or burning sensation that may last a little longer. Those with Trigeminal Neuralgia may experience any of the following symptoms:
- Incidents of sharp, severe pain that feels like an electric shock that lasts for a short while, typically so severe as to cause one to stop activity and wait for it to subside.
- The pain affects the lower face, jaws, and around the cheek area and only affects one side of the face. However, the pain may alternate from one side to another, meaning pain may never be experienced on both sides of the face at the same time. The pain may also spread to areas below the ear and those above the eye.
- Episodes of excruciating pain that last for about two minutes, subside, and leave a burning sensation that lasts longer.
- Occasional spontaneous attacks of pain when brushing teeth, shaving, or wearing makeup that lasts for a few minutes.
- Instances of brief intense pain daily for a few days followed by a remission period that may last for months or years.
- In some rare cases, the pain may last the whole day or for a prolonged period within a day.
- Although the pain is spontaneous, some people sense an impending attack.
Although TN can affect anyone, some factors may increase the risk of developing the painful condition. The risk factors include hypertension, arteriosclerotic vascular changes, individual sensitivity, gender, aging, familial history, and race. Activities that expose individuals to head or facial injuries may also be included as risk factors.
Diagnosis of TN
There is currently no definitive diagnostic test for TN. A diagnosis, therefore, is based on taking a detailed patient history which includes the characterization of clinical signs and symptoms which correspond to those associated with TN and no other diagnosis. Any patient that presents with facial pain should be evaluated for TN especially if the pain is only on one side of their face.
The International Headache Society guidelines below outline the process for diagnosing TN:
Diagnosis for TN1:
- Sudden bouts of pain last for a very short while, usually between a fraction of a second to two minutes which are described as intense throbbing, stabbing, or electric shock-like pain.
- The pain affects one or more divisions of the trigeminal nerve.
- Pain is triggered by these activities – chewing, talking, smiling, brushing teeth, shaving, wearing makeup, kissing, facial touch, washing the face, or head movements.
- Absence of any clinically evident neurologic deficit.
- Pain cannot be attributed to any other clinical disorder.
Diagnosis for TN2:
- Sudden bouts of pain last for a very short while, usually between a fraction of a second to two minutes, but have less intensity compared to TN1.
- The pain affects one or more divisions of the trigeminal nerve and consists of an aching, burning sensation and less likely to be a sharp, intense, superficial, or stabbing pain.
- The pain affects one or more divisions of the trigeminal nerve or may be caused by one of the triggers mentioned above for TN1.
- A causative factor, other than vascular compression, has been identified.
Other Diagnostic Tools
Magnetic resonance imaging (MRI) may also be used as a diagnostic tool for TN. However, general MRI images may not show compression of the trigeminal nerve. A targeted MRI using a high-resolution MR(3T) may be ordered to clearly show the compression on the artery or vein.
Currently, the condition can be managed through nonsurgical or surgical intervention. Patients can also reduce painful episodes by avoiding specific triggers.
The pain caused by TN can be managed using anticonvulsant drugs. A physician may prescribe drugs such as carbamazepine, gabapentin, and oxcarbazepine. Patients can take the drugs whether or not they are experiencing painful bouts. However, prescribed medication should be discontinued during remission periods, as most of them may come with side effects.
Compression on the trigeminal nerve can be corrected through surgical interventions such as Trigeminal Neuralgia Microvascular Decompression. A CNSO neurosurgeon will recommend whether surgery would be beneficial and whether either open surgery or a lesioning procedure would be best to eliminate the compression of the trigeminal nerve.
If a trigger has been identified, patients can reduce the attacks by avoiding the trigger. For instance, if a trigger is shaving, reduce the frequency of shaving or take care to be extra gentle when doing so.
CNSO Can Help
The caring and compassionate team at the Centers for Neurosurgery, Spine & Orthopedics can help patients who are suffering from Trigeminal Neuralgia, also known as tic douloureux. The experts at CNSO, throughout New Jersey will minimize or eliminate the pain and reduce the frequency of attacks. CNSO offers multiple convenient locations across northern New Jersey, including Bergen, Passaic, Essex, Morris, and Hudson counties. Learn more about effectively treating Trigeminal Neuralgia pain by contacting the doctors at CNSO today.