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Trigeminal Neuralgia

What is Trigeminal Neuralgia?

Trigeminal neuralgia is a chronic pain condition that affects one or more branches the trigeminal nerve1, which carries sensation from your face and scalp to your brain. Each attack may last anywhere from a fraction of a second, up to 2 minutes and occasionally longer, and may present as either shock-like, stabbing, shooting or sharp pain1,2 on one side of the face. Frequency of attacks can be anything from 1 to 50 attacks per day2,3,4. The pain is almost always severe in nature and may become more severe over time1. Sufferers may also experience tearing or redness in the eye on the same side as the pain1.

Sufferers of Trigeminal Neuralgia are often extremely hypersensitive and report that slight stimuli such as touching the face, brushing teeth, chewing or even speaking can cause painful attacks, sometimes lasting as little as seconds, or as long as minutes. Typically, the condition is more common in women (60%) than men (40%) and is more likely to occur in people aged over 50 years old4.

Anatomy of the Trigeminal Nerve

The Trigeminal Nerve is primarily a sensory nerve. The Trigeminal Nerve has 3 branches, responsible for innervating different areas of the face and scalp. The Opthalamic branch (V1) innervates the area around the eyes, the front of the nose, and into the forehead and top of the scalp. The Maxillary Branch (V2) innervates the area from the front of the temples, down into the cheeks and the upper lip. The Mandibular Branch innervates the remainder of the temple and jaw, and is also responsible for the motor functions associated with chewing. Trigeminal Neuralgia may affect any of the branches of the Trigeminal Nerve.

Types of Trigeminal Neuralgia

1. Classical Trigeminal Neuralgia

This subcategory of Trigeminal Neuralgia refers to a patient that develops the disorder without apparent cause, apart from neurovascular compression1. This means that the nerve itself has become damaged as a direct result of compression from the vascular system i.e. the veins and arteries. This normally happens at the site of the nerve root, in the brainstem1. Classical Trigeminal Neuralgia can further be split into “Purely Paroxysmal” and “with Concomitant Continuous Pain” with the former being associated with pain-free periods between attacks, and the latter being associated with more mild pain between attacks1.

2. Secondary Trigeminal Neuralgia

This subcategory of Trigeminal Neuralgia refers to a patient that develops the disorder as a result of an underlying disease1. Recognized causes are Multiple Sclerosis, a tumour in the cerebellopontine angle, or arteriovenous malformation1.

3. Idiopathic Trigeminal Neuralgia

This subcategory of Trigeminal Neuralgia refers to a patient that experiences symptoms consistent with Trigeminal Neuralgia, however, they demonstrate no obvious abnormalities via electrophysiological tests or MRIs1. This diagnosis, like Classicial Trigeminal Neuralgia, may suggest pathology of the brainstem.

Trigeminal Neuralgia may also be split into “Purely Paroxysmal” and “with Concomitant Continuous Pain” with the former being associated with pain-free periods between attacks, and the latter being associated with more mild pain between attacks1. Continuous pain in between severe attacks is seen in around half of all Trigeminal Neuralgia sufferers4.

It is not uncommon for Trigeminal Neuralgia sufferers to go undiagnosed for long periods of time or even misdiagnosed, as the symptoms presented can be similar to those of Migraine Headaches, or Cluster Headaches.

What is the cause of Trigeminal Neuralgia?

As explained above, Trigeminal Neuralgia has many causes, as the Trigeminal Nerves are one of the largest nerves supplying the face and head. A common theme among many Trigeminal Neuralgia sufferers is that they have a sensitized brainstem.

A SENSITISED BRAINSTEM will perceive non-threatening stimuli (such as brushing your teeth) from the Trigeminal Nerve as a potential threat and will react, creating excruciating pain to be felt where the sensory information was originally detected. This hyper-excitability of the pain sensation is due to the heightened arousal and sensitive brainstem. A sensitive brainstem will relay the sensory information to the brain, but will heighten the sensation so that the brain perceives the information as painful.

Normal daily activities involving touching the head or face can become “triggers” that set off painful attacks.

I’ve already tried everything. What else can be done to help Trigeminal Neuralgia?

Over-the-counter painkillers, strong anticonvulsant/antispasmodic medications, Botox injections and even surgery are some of the ways in which Trigeminal Neuralgia sufferers have attempted to rid themselves of the painful attacks. In some cases, these ways can alleviate the symptoms of Trigeminal Neuralgia, however despite all of these treatment options, sufferers may still find themselves having painful attacks.

If this is the case for you, have you had your neck assessed? Or, more importantly, have you had your brainstem evaluated in order to investigate the CAUSE of your symptoms, rather than simply masking them?

At the Brisbane Headache and Migraine Clinic™, we have seen countless Trigeminal Neuralgia sufferers and use world-class techniques in identifying whether the neck and brainstem is at fault.

A thorough examination of the upper cervical spine is initiated to determine the severity of your SENSITISED BRAINSTEM.

Once treatment commences we expect a significant improvement to occur rapidly in 90% of our patients with Trigeminal Neuralgia and within the first 5 treatment consultations.

If you suffer from Trigeminal Neuralgia, or if you think it sounds like your symptoms and medication has given you no significant relief, then we believe that you should have a thorough examination of your neck and brainstem.

Imagine living a life free from Trigeminal Neuralgia and saying goodbye to medications!

To gain your recovery today contact us on 1800 HEADACHE (toll free)

1800 43 23 22

 

  1. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. (2018). Cephalalgia38(1), 1-211. doi: 10.1177/0333102417738202
  2. Cruccu, G., Finnerup, N., Jensen, T., Scholz, J., Sindou, M., & Svensson, P. et al. (2016). Trigeminal neuralgia. Neurology87(2), 220-228. doi: 10.1212/wnl.0000000000002840
  3. Pareja, J., Cuadrado, M., Caminero, A., Barriga, F., Barón, M., & Sánchez-del-Río, M. (2005). Duration of Attacks of First Division Trigeminal Neuralgia. Cephalalgia25(4), 305-308. doi: 10.1111/j.1468-2982.2004.00864.x
  4. Maarbjerg, S., Gozalov, A., Olesen, J., & Bendtsen, L. (2014). Trigeminal Neuralgia – A Prospective Systematic Study of Clinical Characteristics in 158 Patients. Headache: The Journal Of Head And Face Pain54(10), 1574-1582. doi: 10.1111/head.12441

 

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