Trigeminal neuralgia—also known as tick douloureux—stems from a disruption of the nerve’s function, usually caused by contact between a normal blood vessel and the nerve at the base of the brain, putting pressure on the nerve. This contact can be the result of aging, related to multiple sclerosis or a similar disorder, from a tumor or brain lesion, or from a stroke or facial trauma. The resulting pain, sometimes described as the most excruciating pain known to humanity, can be debilitating.
The trigeminal nerve is the fifth cranial nerve (of 12), and the largest. It is the primary sensory nerve of the head and face and has three branches: the ophthalmic nerve, the maxillary nerve, and the mandibular nerve. The ophthalmic nerve carries sensory information from the scalp, forehead, upper eyelid and eye, nose, and sinuses. The maxillary nerve carries the same from the lower eyelid and cheek, nares and upper lip. upper teeth and gums, nasal mucosa, palate, roof of the pharynx, and some parts of the sinuses. The mandibular nerve carries sensory information from the lower lip, teeth and gums, chin, jaw, external ear, and parts of the meninges. It also carries sensations from the mouth and sensation from the tongue (via the lingual nerve, oneof its branches).
Because this one nerve carries sensation from your face to your brain, when there’s a problem, you know it. With trigeminal neuralgia, even mild stimulation of the face—such as washing, brushing teeth, shaving, or even eating, talking, smiling, or encountering a breeze—may trigger jolts of pain, from mild to excruciating. The pain can range from severe shooting or jabbing pain that feels like an electric shock to constant aching or burning.
The duration also varies: sometimes spasms may last for only a few seconds. Some episodes may include a series of attacks lasting days, weeks, or even months. When the pain is frequent and severe, it can be debilitating, isolating, and depressing. According to the National Institute of Neurological Disorders and Stroke , about 12 in 100,000 people—about 150,000—are diagnosed with trigeminal neuralgia per year. It most often occurs in those over age 50, though it can occur at any age, and is more prevalent in women than men.
Treatment options for the condition vary depending upon the cause and severity. Medications include anticonvulsants, tricyclic antidepressants, and opioids. One new substance has been successfully tested in a phase II trigeminal neuralgia research study involving the Center of Dental Medicine at the University of Zurich. The substance tested, BIIB074, blocks the channel conveying pain signals from the nerve cell membranes to the brain, varying its strength depending upon the activity of the channel. “Unlike conventional drugs, which often cause tiredness and concentration problems, BIIB074 was not only effective; but also very well tolerated,” explains Dominik Ettlin, a dental specialist from UZH. The drug is proceeding to the next phase of study.
If medications are ineffective or become less effective over time, there are several surgical options. In fact, a study published by the Cleveland Clinic suggests that radiosurgery should be considered earlier on than it is typically. Dr. Samuel Chao, one of the authors, states that “Using radiosurgery earlier on allows patients to get off the medications, improving their quality of life by allowing them to return to activities they used to do.”
Ultimately, increased research funding and participation in clinical studies is the best way to discover new treatments for trigeminal neuralgia. Meridien Research has trigeminal neuralgia studies at our Tampa clinic. For more information or to see if you or someone you know may qualify to participate, please contact us today at 813-877-8839 or visit our individual study pages.