The quality of life of patients diagnosed with trigeminal neuralgia is heavily impacted, preventing people with this condition from going about their day-to-day activities. If it is not treated properly, it can lead to anxiety and depression.^3,4

Introduction

Definition of trigeminal neuralgia (TN)

Trigeminal neuralgia, also known as tic douloureux, is a chronic condition caused by vascular compression near the trigeminal nerve (i.e., a large three-part cranial nerve). As a result of this compression, the individual suffers chronic episodes of pain resembling an electric shock in the parts of this nerve that are connected to the face. This condition is characterized by unilateral and short-lasting surges of pain ⁽⁵⁾. 

Prevalence and demographics

Trigeminal neuralgia is a rare condition, which is more common in women, especially those over the age of 50. The prevalence of this disorder is about 4 new cases per 100.000 people.²

Background information

Anatomy and physiology of the trigeminal nerve

Structure and function

The trigeminal nerve is the fifth (V) cranial nerve of a group of twelve cranial pairs. The name comes from its three branches, the ophthalmic branch, the maxillary branch, and the mandibular branch. Every branch transfers different sensory inputs from parts of the face to the brain. For instance, the mandibular branch is responsible for relaying both sensory and motor input from the jaw, for movements like mastication.²

Pathways involved in TN

As mentioned above, three areas are covered by the trigeminal nerve, ophthalmic, maxillary, and mandibular. In which, each branch innervates (i.e., supplies nerves to) the following areas:⁵

• Ophthalmic nerve(V1): from the upper eyelid to the lower eyelid
• Maxillary nerve (V2): from the lower eyelid to the lower lip
• Mandibular nerve (V3): from the lower lip to the jaw´s baseline

Etiology 

The main cause of trigeminal neuralgia is the functional disruption of the trigeminal nerve due to a blood vessel compression, whether the vessel is an artery or a vein.¹

However, blood vessel compression is not the only cause of trigeminal neuralgia. Trigeminal neuralgia can also be caused by multiple sclerosis, a brain tumour, or as a result of a stroke or facial trauma.¹

Clinical presentation of TN

Symptoms and diagnostic criteria

One or more of the following symptoms can appear during a TN episode:¹

• Intense shooting pain which can be described as the feeling of an electric shock
• Pain can appear suddenly or after a trigger contact, like a simple touch or a gust of wind
• Pain can last from a few seconds to several minutes
• Pain is localised across the innervated area of the trigeminal nerve
• Unilateral pain

Severity and frequency of pain episodes

The frequency of trigeminal neuralgia episodes can last days or even months, and the pain intensity can increase over time. In some cases, people may experience periods without pain, this is referred to as remission.¹

Impact on quality of life

Trigeminal neuralgia has significant negative effects on the quality of life of those suffering from it, regardless of the duration of the pain or its intensity.³

Perhaps because of this, it is unsurprising that anxiety and depression are commonly observed in patients with TN. Emotional and psychological support may be needed in such cases.⁶

Over time, patients experience mental distress and frustration due to the long-term chronic aspects of the pain associated with trigeminal neuralgia. This also tends to negatively impact their ability to work, and productivity.⁷

Treatment options and their impact on quality of life

Pharmacological treatments

Pharmacological interventions are often the first line of treatment for trigeminal neuralgia. Initial treatments for this condition involve antiseizure agents (such as carbamazepine or oxcarbazepine). The majority of patients present a good response to the treatment at early stages. Initially, the doses are low and gradually increase until the pain is under control. Pain relief usually occurs after two weeks of treatment. Nevertheless, the efficiency of antiepileptics drugs may decrease over time in some patients.⁵

Antiepileptic medications can have side effects including dizziness, diplopia (double vision), and nausea.⁵

Surgical Interventions

Surgical interventions are considered when the pain becomes unmanageable, usually after reaching the maximum pharmaceutical dose. Some surgical interventions include microvascular decompression, rhizotomy, peripheral neurectomy, nerve blockade, deep brain stimulation, and botulinum toxin (botox) injections. The effectiveness and recurrence of pain after these interventions can vary.⁵

Surgery complications and risks should be considered, including hearing loss, cerebellar hematoma, cerebrospinal fluid leaks, and facial weakness.⁵

Coping strategies and support

Medical Interventions

One possible strategy used to alleviate trigeminal neuralgia symptoms is to recognise the symptoms early and plan in advance to take the prescribed medications slightly before or after symptoms appear.⁸

Vitamin intake

The intake of vitamin B complex, in particular, vitamin B12, has shown improvements in the functionality of the trigeminal nerve.⁸

Seek counselling or psychological support

Therapy can be extremely beneficial to an individual’s mental health. After remission, patients can experience anxiety attacks due to the uncertainty and fear of new episodes reoccurring in the future. Psychological support can provide essential tools to overcome these emotions and learning how to feel in control of these situations.⁸

Join a support group

The majority of patients say that sharing experiences with others who are dealing with the same struggles gives them a sense of belonging. Joining a local support group could be beneficial and would help avoid isolation.⁸

Knowledge of numbers

Understanding the triggers, times, duration, and other characteristics of trigeminal neuralgia episodes can help minimise episodes and stress.⁸

FAQ’s

How does trigeminal neuralgia affect your daily life?

The pain provoked by trigeminal neuralgia affects a range of common daily activities, such as your occupation, routine, and social life. 

Does trigeminal neuralgia affect your life expetancy?

Life expectancy is not affected by trigeminal neuralgia disorder.

How to brush your teeth if you have trigeminal neuralgia?

Brush your teeth with a soft toothbrush, to avoid pain. 

Summary

Trigeminal neuralgia is a rare condition, common in women over 50 years old. It is described as a chronic pain condition affecting the innervated areas of the forehead, cheek, and lower jaw. The pain is characterised as a lateralized electric shock. This pain can affect the quality of life of sufferers, not only physically, but emotionally and socially. It is important that patients seek medical attention, follow medical treatment, and build an emotional support system, in order to minimise the effect of this condition on their physical and mental wellbeing.