(TN), also called tic douloureux, is a condition that affects the trigeminal
nerve (the 5th cranial nerve), one of the largest nerves in the head. TN is
primarily known for the intense level of pain it causes. The trigeminal nerve is
responsible for sending impulses of touch, pain, pressure and temperature to the
brain from the face, jaw, gums, forehead and around the eyes. The disorder is
more common in women than in men and rarely affects anyone younger than 50.
What are the symptoms of trigeminal neuralgia?
TN is characterized by a sudden, severe, electric shock-like
or stabbing pain typically felt on one side of the jaw or cheek. The attacks of
pain, which generally last several seconds and may be repeated one after the
other, may be triggered by talking, brushing teeth, touching the face, chewing
or swallowing. The attacks may come and go throughout the day and last for days,
weeks or months at a time, and then disappear for months or years.
What causes trigeminal neuralgia?
The exact cause of TN is not known. However, certain factors -
such as physical nerve damage and stress - can trigger the beginning of the
painful attacks. Nerve damage may occur as the nerve passes from the openings in
the skull to the muscles and tissue of the face. As the damage compresses the
nerve, the nerve cells shed a protective and conductive coating known as myelin.
Myelin acts as an insulator. Without this insulation, information from nerves
would be transmitted inefficiently. This may result in weakness, sensory loss or
other neurologic dysfunction. Damage may also be the result of a biochemical
change in the nerve tissue itself or an abnormal blood vessel compressing the
nerve as it exits from the brain. In almost all cases, an excessive burst of
nervous activity from a damaged nerve causes the painful attacks.
In people without TN, blood vessels are usually not in contact with the
trigeminal nerve root entry zone. Though pulsation of vessels upon the
trigeminal nerve root do not visibly damage the nerve, the irritation from
repeated pulsations may lead to changes of nerve function and delivery of
abnormal signals to the trigeminal nerve nucleus. Over time, this may cause
hyperactivity of the trigeminal nerve nucleus which results in the generation of
Psychological stress can be the cause as well as the outcome of TN. In clinical
studies, patients have been known to report TN following major stress like
divorce, the death of close family members, a job change, or unhealthy family
How is trigeminal neuralgia treated?
Medications are the first line of treatment for TN and include
drugs such as Carbamazepine (Tegretol®), Phenytoin (Dilantin®), Gabapentin (Neurontin®),
and Baclofen (Lioresal®). There is also a controled trial using Lamotrignine (Lamcital®).
Many of the medications used to treat TN are those originally designed to treat
seizures. The anti-seizure agents in these medications suppress excessive nerve
tissue activity. If pain becomes more frequent and severe, increased doses of
medications are required. This may lead to intolerable side effects and/or
inadequate pain control. Since TN is extremely painful, but not life
threatening, the goal of therapy is to minimize the dangerous side effects.
If medications do not adequately control TN that progressively worsens, surgical
procedures are considered to be the next line of treatment. The surgical
procedures considered may include either microvascular decompression (MVD)
surgery; alcohol or glycerol injections into the trigeminal nerves; gamma-knife
treatment; or some form of nerve injury procedure (rhizotomies). A neurosurgeon
can perform MVD surgery if the doctors can successfully determine the cause of
the disorder to be compression of an artery on the trigeminal nerve deep inside
The major disadvantage to surgery is that it requires a neurosurgical operation
— with all its complications — to get access to the root of the trigeminal
nerve. The success rates of the surgical procedures vary according to the
experience of the surgeon or the anesthesiologist.
What do we know about heredity and trigeminal
The exact role of heredity regarding TN remains unclear.
However, estimates suggest that roughly 5 percent of TN patients have a history
of other family members who have had the disorder. Familial TN has been noted to
be more common in women, mostly in women older than 50 years. This has led to
speculation that there is a dominant pattern of genetic transfer.
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Nutritional and Herbal Therapy for
The nutritional therapy for trigeminal neuralgia aims at
nutrients that soothe and strengthen the nervous system and avoid foods and
drinks that irritate it.
- Vitamin B Complex (50 mg three times a day)
Very important to ensure the proper functioning of the nervous system.
- Magnesium (250-500 mg once a day) Essential
for proper nerve functioning. It also relaxes the nerves.
- The following are very helpful herbal restoratives:
Scullcap (Scutellaria lateriflora), Damiana (Turnera
diffusa) and Oats (Avena sativa).
- Avoid foods high in sugar, salt, trans-fatty acids,
saturated fats and caffeine.
- Do not smoke
- Corydalis Relieve Pain Pills is a Chinese herbal
formula that can be helpful for trigeminal neuralgia pain. For added
benefit, combine with the formula, Xue Fu Zhu Yu Wan.
- Cayenne fruit/pepper (Capsicum annum) is helpful
for pain relief.
- Evening Primrose oil (1,000 mg twice a day) is an
excellent source of essential fatty acids. It acts as an anti-inflammatory.
- Massage the area lightly with apple cider vinegar.