Trigeminal Neuralgia Prompt treatment is key to coping with this
lightning-like condition. BY RACHEL GRUMMAN
What is it? Trigeminal neuralgia (TN), also known as “the suicide disease,” is an excruci- ating type of facial pain brought on by irritation of a nerve in the brain that has three “arms,” each of which sup- plies sensation to different parts of the face, including the teeth, gums, lips, jaw, cheek and nose, explains John Delfino, D.M.D., a clinical professor of anesthesiology at New York Univer- sity School of Medicine, in Manhattan. People with TN may go into remission for several months, or even years, for no known reason, and then the TN recurs, often with a vengeance.
What does it feel like? The condition triggers a severe, sharp pain that feels like an electric shock in an area of the face, such as the cheek or lips (though over time the pain can progress to other parts of the face, says Delfino). An attack typically lasts for a few seconds, and they can become more frequent and intense over time. Some sufferers also experience a tem- porary burning sensation along the pain’s path after a flare-up. “In 95 per- cent of cases, the pain only occurs on one side of the face,” Delfino adds.
Who suffers from it? More common in women than men, TN affects about five out of every 100,000 people each year; typical age of onset is 60. Patients with multiple sclerosis (MS) are 20 times more like- ly to develop it because sufferers lose the myelin sheath that protects the trigeminal nerve.
What causes it?
TN happens when a blood vessel rubs against the trigeminal nerve as it exits the back of the brain. That friction
Trigeminal neuralgia can make everyday tasks like applying makeup painful.
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damages the protective layer of the nerve, which begins to fire haphaz- ardly—much like an exposed wire— causing intense pain in the areas of the face supplied by that nerve. Simply touching any of these trigger areas, as well as everyday activities, such as brushing your teeth, chewing, talking and blowing your nose, can set off the pain. The excruciating feeling can come from out of the blue or be trig- gered by MS, physical damage to the nerve or a tumor pressing on the nerve.
How is it diagnosed? A doctor will take a thorough history and perform a physical exam of the areas of the face where you feel pain.
Comprehensive magnetic resonance imaging (MRI) of the brain can look for an artery that’s close to the trigem- inal nerve. “That gives you the tip-off you need for a diagnosis,” says Delfino. Which doesn’t mean TN is always simple to diagnose, he adds. “So many other issues can cause facial pain that one has to be very careful.”
How is it treated? Medications are likely to be your first line of defense: Prescription anticon- vulsants, such as Trileptal (oxcarbaze- pine) and Neurontin (gabapentin), tranquilize the nerve so it doesn’t keep firing. “These medications are taken to the point where patients no longer have pain [including breakthrough pain] and then we taper down the drug,” Delfino notes. If you go into re- mission you’ll be taken off the drug and closely monitored by your neu- rologist. If drugs do not help, more invasive (continued on page 62)