Trigeminal neuralgia (also known as tic delaroux) is a disorder characterized by a severe, electrical shooting pain in the face. The trigger area on the face is typical around the nose or upper lip. Affected individuals experience a brief but intense electrical or burning pain on the affected side of their face. Trigeminal neuralgia typical affects only one side of the face. The cause of this disorder is unknown in most cases and it is not hereditary. On rare instances, there can blood vessels pushing up against the nerve. Patients with trigeminal neuralgia find that air blowing across their face, brushing their teeth, chewing, washing their face, putting on make up or drinking hot/cold beverage will trigger severe pain attacks. At times, talking can even trigger pain episodes. They can have trouble sleeping at night if they lay on the affected side. Although the majority of individuals with this condition are over the age of 50, it can begin at younger ages. Patients may have daily face pain attacks for weeks to months and then the condition will suddenly go into remission for a period of time. This remission period may last weeks to months but then reoccurs as severe as ever. Other less fortunate individuals have the pain continually.
Fortunately good non-narcotic medical treatment exists to control pain. The main medication used is an antiseizure medication called carbamazepine (Tegretol.) This medication is considered by many to be the drug of choice for treatment of this condition. Tegretol frequently provides excellent, prompt relief and control of facial pain. For patients who cannot tolerate Tegretol, or for those who do not respond, there are severe other antiseizure medications that can be helpful. These include Trileptal, Topamax, Lamictal, Neurontin and Lyrica. Another medication, which is not in the antiseizure class, is amitriptyline. It is important to note that narcotic pain killers do not work well for trigeminal neuralgia and should be avoided.
For patients with intractable trigeminal neuralgia that does not respond to the typically used medications, surgery may be an option for treatment. There are severe surgical procedures that can be effective. Radiofrequency rhizotomy is a commonly performed procedure that provides good pain relief for many patients. It is not an invasive procedure which increases the safety. Glycerol (alcohol) rhizotomy is a similar procedure that can be tried. Gamma knife surgery procedure is a noninvasive treatment using focused radio waves to ablate the nerves responsible for pain. These are the more common surgical procedures used to treat trigeminal neuralgia but should be reserved only for those patients who have not responded to several different medication trials.
For diagnosis, it is necessary to see a neurologist familiar with this condition. Patients all too frequently go to a dentist, thinking they have some type of dental problem. I have seen patients who have had multiple teeth taken out as well as root canals and yet their pain persists. This is because trigeminal neuralgia is not a dental problem. Do not suffer unnecessarily, get into to see a physician who can help.
{ 10 comments… read them below or add one }
I was diagnosed with trigeminal neuralgia about 3 years ago. My Dr. put me on neurontin, which seems to help. He just upped my dose since pain is more intense and happens more often.
I am one of those who had several root canals and a tooth pulled because I was sure that was the cause of my pain. Well, I still have pain in that upper molar region…pain in my jaw, over my eye, and pain that has recently started in the area of the tooth right next to my middle tooth.
I met a man in my neighborhood who has ‘tic’, has had the surgery which worked for a couple of months and then he was in severe pain again. He recently had a procedure where he was put to sleep and given an injection inside the mouth, into the jaw, to deaden the nerve. Now he has little or no pain, but his face is drooping, his eye feels like it has sand in it all the time, his tongue is numb, therefore he keeps biting it, sense of smell and taste has been affected…etc. It just goes on and on!
I am frustrated and certainly feel for other sufferers. I can honestly say, I live in a state of fear. I am very afraid of the pain!
I have had this electrical pain in my right jaw off and on for six months.
At first my doctor put me on amoxicillin. Then she tried Cipro and the pain went away. Thinking that was the solution I was pain free for several weeks and the tic returned worse than ever.
Next I went to dentist for 360 degree xray, no good. Then I waw put on Cipro, no good. Then she put me on Tegrtol and so far it has worked.
I have never had pain this bad.
hello – i have sufferred horrid facial pain and neck pain on my right side, may be tn, may be eagles syndrome, may be something else – but nothing helped me unless i took something and was knocked out – lost my profession and self-esteem – tried everything – intraoral injections helped some – but want you all to know that BOTOX IS AMAZING – my doctor put it in my shoulder up to the base of my head and then on the side of my face in several places and a little in my forehead – I was a complete skeptic – after two weeks, I called his office to say this did not work but then the third week, I began to notice that my days were longer and better and less pain filled – my headaches weren’t as severe – everything had lightened up and I could actually turn my head without pain. It did not paralize my neck or shoulder muscles at all – I went back singing his praises after three months and he did another round of injections – I’m still doing pretty good – today was a bad headache day – but not nearly as bad as usual – I AM TRULY BLESSED TO HAVE FOUND A DOCTOR WHO WAS WILLING TO USE BOTOX TO TRY TO HELP ME.
IT IS QUITE DRAMATIC. I’M VERY GRATEFUL.
PLEASE ENCOURAGE YOUR DOCTOR TO USE IT FOR YOU AND IF HE WON’T, FIND ONE WHO WILL.
BLESS TO YOU ALL, HELEN
For those of you who have this problem. I sincerely feel for you in your nightmare. This is what it is the most excruciating pain imaginable. I am afraid to go to sleep mine happens at night. I have had up to 10 episodes in one night. You try to stay awake because you know that 10 minutes after you go to sleep there it is again.
I take tegretol and have at times had to take 1400mg a day. I am now down to 1 1/2 tablets at night with using a illegal drug. I take 2 puffs before going to bed usually about an hour before bed time. And I sleep all night. If I have a bleed through it is minor and not as painful.
I have spent hours with hot towels (burning my face) drinking hot tea or coffee and I have found that inside the roof of my mouth way up in the right hand corner that during these episodes that I will get a swelling of something inside my head if i take my thumb and press on it. It aleves the pain somewhat.
But so far the only solution that really works is illegal. Montel Williams who has MS says it works for him. And since this is caused by loss of myelin sheath around nerve. I thought i would try it. It works
Recently treatments on a DRX-9000 decompression machine were completed… & after 8-treatments I experienced a twitch on my upper right lip area & was wondering if the treatments can cause this reaction..??
Thank You Jim Labor
Hi Jim,
I’m not personally familiar with the DRX-9000 therapy technique. I would suggest that you contact a local Neurologist familiar with treatment of trigeminal neuralgia.
Good Luck and Thanks for Posting,
Dr. Kassicieh
I started suffering with T.N. in October of 08. I went to the Dentist, they did X-Rays, was sent to an Orthodondist, neither could find anything pathologically wrong with my teeth or gums. My Dentist decided it was Tic D. It would come and go away for weeks and sometimes months, when it returned it returned with a vengence. One night I couldn’t take it any more and went to the ER. The Doctor gave me a Prescription for Tegretol and Neurontin. The meds have helped me. I will be seeing a Neurologist.
I also have TN. Reading these stories made me cry. Not only is this a painful condition…It is debilitating, ruthless and very much affects your life physically and emotionally…It’s just unbearable. I admire you all and send my prayers. I am about to get Botox..I really hope it helps and covered by insurance. We deserve all the kindness and help that we can get.
What every TN sufferer has in common? Extreme fear of the next attack.
I am writiing in regards to my husband, Kenneth, who is suffering with TN. His is located only in the left temple area but, it is VERY painful. He had surgery September 2008 where they put the teflon coating in the back of his neck. This was OK for a while (18 mos) but the pain is back. He still has numbness on the left side of his face, sand feeling in the eye, and no taste. It came back about 6 weeks ago and is now in the left temple area. He has tried several of the meds you mentioned but, they don’t seem to be helping. Any suggestion on Lyrica?? or any other medication that has been tried and worked. He does not want more surgery because they said to do surgery in the temple are in all probably would left his whole face numb and that would very difficult to live. I would appreciate any suggestions that anyone would have to give us something to work with. In advance, I thank you so much for listening.
God bless you all
Joan Fatica (Ken’s wife)