Trigeminal neuralgia (TN), tic douloreaux, is a common painful condition of the face that usually affects one side of the face producing brief, severe, sharp, and electric pain.
Trigeminal neuralgia is defined by the International Headache Society as "intermittent attacks of facial or frontal pain that last a few seconds to less than two minutes without neurological deficits or any other causes of facial pain." The pain has at least four of the following five characteristics: 1) distribution along the trigeminal nerve; 2) sharp, superficial, sudden, stabbing, or burning pain; 3) severe pain intensity; 4) precipitation from trigger areas or daily activities; and 5) no symptoms between attacks.
The prevalence of TN is 100 per 100,000 with an incidence of five per 100,000 per year. TN is twice as common in women. The average age on onset is 50 years of age. There is a family history of TN in five percent of patients who have subsequently have a greater likelihood of bilateral involvement.
Many cases of TN that were originally though to be idiopathic without any identifiable lesion are due to vascular compression. Fifty percent of these patients who undergo a decompression of the trigeminal nerve are pain free for an average period of 15 years. Additional types of lesions are found in up to 15% of TN patients.
TN must be differentiated from intracranial tumors, nasopharyngeal tumors, post herpetic neuralgia, dental disorders, cluster headaches, and migraine headaches.
Although the natural course of TN is not known, TN is considered to be a chronic condition that lasts a lifetime. Some patients can have long periods of remission lasting months to years.
Treatment for TN includes oral medications and surgical intervention. Tegretol is the drug of choice in treating TN. Other anticonvulsants have also been used to treat TN. The most frequent surgical treatments are gamma knife tractotomy, radiofrequency gangliolysis, retrogasserian glycerol injection and micro-vascular decompression.
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I wanted to pass along a web site that might be useful to some of your patients. Please be sure to tell them we are an online support group helping connect people living with TN -- *not* a source of medical information.
http://www.livingwithtn.org
Ben
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