Symptoms
- Flashing, stabbing, sharp, short-lasting pain in the cheek, lips, chin, and lower jaw
- Muscle spasms (“tic douloureux”).
- Hypersensitivity to touch
- Weight loss: chewing causes pain, patients stop eating
- Usually unilateral, very rarely bilateral.
Trigger:
- Touching, washing, shaving, smoking, talking, brushing teeth, eating and the like.
- Trigger zones: Small areas in the nasolabial fold on the chin can trigger the pain.
- Often also spontaneous
Causes
Classic trigeminal neuralgia: idiopathic, possibly due to demyelination of the nerve Symptomatic trigeminal neuralgia: secondary as a result of an underlying disease, eg, multiple sclerosis, neuritis, tumors, gout, depression, stress medical clarification (eg, MRI).
Risk factors
- Female gender
- Age
- Multiple sclerosis
- Hypertension
Non-drug treatment
- Cryotherapy: treatment with cold by cold water or ice packs.
- Surgery
Drug treatment
Antiepileptic drugs:
- Carbamazepine (Tegretol) is clinically well studied and used initially, supplemented by other agents if ineffective. Problem: adverse effects, interactions.
Neuroleptics Opioids ?
- Treatment of the underlying disease in symptomatic trigeminal neuralgia.
Over-the-counter (OTC) trials:
- Capsaicin was tested in an open study (Epstein, Marcoe, 1994 Pubmed) and can be applied topically as an ointment. It should not get into the eyes (see under capsaicin)!
- NSAIDs are often ineffective
