Tic douloureux, also known as trigeminal neuralgia, causes chronic pain as a result of pressure put on the trigeminal nerve of the head. The main symptom of the condition is pain, which can be triggered by common actions such as eating and drinking. Tic douloureux treatment options include medication and surgery.
The trigeminal nerve begins at the base of the brain and extends to several areas over the face. There are three main branches of the trigeminal nerve, which cover lower, middle, and upper parts of the face, and supply them with the ability to feel sensation. The upper branch affects the scalp, forehead, and upper nose, and the middle affects the cheek, sides of the nose, upper jaw and lip, and teeth and gums. The lower branch of the nerve affects the lower jaw, lip, teeth, and gums. Tic douloureux can affect one branch of the trigeminal nerve, or may affect two or three.
Tic douloureux is characterized by its main symptom: pain. Trigeminal neuralgia causes a distinctive type of stabbing pain which can be likened to an electric shock due to its suddenness and severity. The pain is of very short duration, usually just a few seconds, but it is common for several stabs of pain to be experienced one after the other, with repeat episodes possible in the same day. Pain may occur every day or every few days for months or years, sometimes interspersed with periods of dormancy in which no episodes are experienced.
Trigeminal nerve pain can be triggered by everyday activities such as eating and drinking, brushing the teeth, applying makeup, or talking. Even exposure to wind can trigger the pain; in fact any type of motion or activity which involves contact with the cheek, or vibration of the cheek, can trigger pain. It is rare for pain to occur when a patient is asleep.
The pain is thought to be caused by blood vessels which put pressure on the trigeminal nerve. Over time, this erodes the protective myelin sheath which covers the nerves, which leads to nerve pain. While this condition is not fatal, it is extremely debilitating and can cause considerable emotional stress as well as physical pain. Many people with the disorder begin to avoid any activities which may trigger pain. This becomes exceptionally difficult because some triggers, such as eating and drinking, cannot be avoided.
Most cases of Tic douloureux can be treated effectively with anticonvulsant medication. These work by preventing neurons from firing in the affected nerves, thus preventing facial pain. Antidepressants are usually prescribed for the constant burning or aching pain which some people experience.
Tic douloureux surgery is recommended for people who find no relief with medication. There are several options for surgery, including balloon compression, which prevents pain by causing a small amount of damage to affected nerves. Another option is called glycerol injection, and involves the injection of a small amount of the substance to the area around the affected nerves. The glycerol similarly damages the nerves such that pain is no longer experienced. A more invasive procedure called microvascular decompression is generally the most successful, as this involves physically moving the blood vessels which are putting pressure on the nerves.