Types of TN, symptoms, triggers, causes, diagnosis and treatments.
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Trigeminal neuralgia, TN, is a chronic pain syndrome caused by compression of the trigeminal nerve. The trigeminal nerve has 3 branches, each conveys sensation from a section of the face, including paranasal sinuses and the nasal and oral cavities. The location of the pain varies depending on the branch that is affected, but more than one branch can be compressed at a time. There are two trigeminal nerves, one on each side of the face. Typically (though not always), only one nerve, and hence one side of the face, is affected.
The most common type of TN, named TN1, is characterized by sporadic episodes of excruciating facial pain that last anywhere from seconds to minutes, and can occur up to a hundred times a day. The pain is often described as intense, stabbing or electric shock-like. The episodes can be triggered by facial movements or contacts with the face, such as when washing, shaving, brushing teeth, applying makeup, eating, drinking, talking, or even upon light touch or exposure to a light breeze.
There is also an atypical form of TN, named TN2, which manifests as a constant, similar, but less intense pain than TN1. Some patients may experience both TN1 and TN2.
The condition typically evolves in cycles, with periods of frequent episodes followed by periods of partial or complete remission with little or no pain. With time, however, the pain attacks often intensify and pain-free periods become shorter and less frequent.
TN can occur in anyone but most commonly affects women over the age of 50.
Compression of trigeminal nerve is often brought about by a pressing blood vessel, but a tumor or other abnormal structures can also be the cause. Injury to the nerve may also result from facial trauma, stroke, facial surgery complication, or conditions such as multiple sclerosis.
Diagnosis is difficult as many other disorders may produce similar pain patterns and must be ruled out. MRI scans can reveal tumors or multiple sclerosis lesions. A high-resolution, three-dimensional MRI or newer scanning techniques can detect nerve compression by a blood vessel.
People with TN type 1 typically respond well to anticonvulsant medicines. Pain relievers are not usually effective, although a small number of patients with TN2 do respond to opioids. Muscle relaxants and Botox injections may be helpful to some. Most medications, however, lose their effectiveness over time.
A number of surgical procedures are available to decompress the nerve, or to sever the nerve to block pain. Microvascular decompression surgery is most effective but also most invasive and carries more serious risks. Rhizotomy procedures are less invasive but because they deactivate the nerve to stop pain, the nerve’s normal function of conveying sensation is also lost, resulting in facial numbness. The effect of rhizotomy is also shorter-lasting, leading to sooner recurrence of pain.
Finally, some patients may benefit from exercise, yoga, aroma therapy, meditation, vitamin or nutritional therapy, and acupuncture or chiropractic treatments.
