What is Trigeminal Neuralgia (Tic Douloureux)? Symptoms and Treatment

The shortest answer to the question of what trigeminal neuralgia is: it is a severe chronic pain syndrome that suddenly appears on one side of the face, creating a sensation of an electric shock or stabbing. Recognised in the medical world as one of the most excruciating pains known to humanity, and commonly referred to as "Tic Douloureux", this condition occurs due to the dysfunction of the trigeminal nerve. Patients typically describe this experience as feeling like a lightning strike in the face. Although it deeply affects daily life, this condition can be successfully managed with an accurate diagnosis and modern medical approaches.

Trigeminal Neuralgia at a Glance

• It generally affects individuals over the age of 50 and is twice as common in women as in men.
• Simple actions such as eating, brushing teeth, or being exposed to the wind can trigger the pain.
• Symptoms are divided into two main groups: Type 1 (sudden and sharp) and Type 2 (constant and aching).
• Neurological examinations and detailed Magnetic Resonance Imaging (MRI) are used for diagnosis.
• Specific nerve medications are primarily preferred for treatment; surgical methods step in for resistant cases.

What is Trigeminal Neuralgia (Tic Douloureux)?

The trigeminal nerve is the fifth cranial nerve that emerges from the brain, spreads across the face, and transmits sensations such as touch, pain, and temperature to the brain. This nerve divides into three main branches: around the eye, the upper jaw, and the lower jaw. Trigeminal neuralgia is a severe pain condition that occurs in attacks as a result of the stimulation of one or more of these branches. Every year, approximately 150,000 people worldwide are diagnosed with this condition.

Although the disease usually appears in individuals aged 50 and over, it can rarely be seen in young adults. This condition, which affects women more than men, severely reduces the patients' quality of life. Pain attacks can last from a few seconds to a few minutes, but they can repeat many times throughout the day, leaving the person exhausted. In the early stages of the disease, attacks may be short and mild, but over time they can become longer and unbearable.

Causes and Risk Factors of the Disease

The primary cause of trigeminal neuralgia is pressure or damage to the nerve at the point where it exits the brainstem. Medically, this condition is divided into two main categories: primary and secondary. In the vast majority of primary trigeminal neuralgia cases, a normal blood vessel (usually an artery or a vein) adjacent to the nerve presses against it. This constant contact leads to the wearing away of myelin, the protective sheath of the nerve, causing the nerve to produce abnormal pain signals.

Secondary trigeminal neuralgia, on the other hand, stems from another underlying health issue. Diseases that destroy the myelin sheath, such as multiple sclerosis (MS), tumours pressing on the nerve, cysts, severe facial trauma, or nerve damage due to previous surgical operations fall into this group. Risk factors include advanced age, genetic predisposition, and hypertension.

Common Triggers

One of the most challenging aspects of the disease is that the pain can be triggered by very ordinary daily activities. Washing your face, shaving, applying makeup, chewing food, consuming hot or cold drinks, brushing your teeth, talking, smiling, and even a light breeze can start an attack. Exposure to cold wind, especially during the winter months, can increase the frequency of attacks. To protect yourself from the other effects of cold weather on your skin and facial area, you can also review our article titled Skin Barrier is Sounding the Alarm: 5 Defence Tactics in Cold Weather.

What are the Symptoms of Tic Douloureux?

Trigeminal neuralgia symptoms can vary from patient to patient and are divided into two main types based on the character of the pain. The pain is mostly felt on only one side of the face (unilateral); it is quite rare for it to affect both sides simultaneously. While it is most commonly seen in the lower jaw and cheek area, it can sometimes spread around the eye, forehead, and lips.

• Type 1 (Classic Trigeminal Neuralgia): This is the most common form. It is characterised by sharp and throbbing pains described as a lightning strike, electric shock, or stabbing sensation in the face, which start suddenly and end within seconds or minutes. Between attacks, the patient is completely pain-free.
• Type 2 (Atypical Trigeminal Neuralgia): In this type, the pain is more constant, aching, burning, and dull in character. Sudden severe attacks are less frequent, but the sensation of pain continues in the background for most of the day. Its treatment can be slightly more challenging than Type 1.

How is it Diagnosed at the Hospital?

The diagnosis of trigeminal neuralgia begins with listening to the patient's complaints in detail and a careful neurological examination. Your doctor will question exactly where the pain starts, how long it lasts, and what actions trigger it. It is checked whether the pain conforms to the distribution of the trigeminal nerve.

To confirm the diagnosis and rule out underlying secondary causes (tumour, MS, etc.), taking a high-resolution Magnetic Resonance Imaging (MRI) scan is a standard approach. Thanks to special MRI sequences, the nerve's exit point from the brainstem is examined in detail, and any vascular compression is detected. When necessary, the evaluation of our Dermatology specialists may also be requested to distinguish it from skin diseases like shingles, which present with a rash and pain on the face.

Trigeminal Neuralgia Treatment and Surgery Options

The treatment for trigeminal neuralgia is personalised according to the patient's age, general health status, the severity of the pain, and the underlying cause. The treatment process usually begins with medications, and if there is no response, surgical options are evaluated.

Medication Treatment

Traditional painkillers generally do not work for trigeminal neuralgia pain. The foundation of the treatment is formed by the anticonvulsant (anti-seizure) group of drugs. Carbamazepine is the most frequently prescribed first-choice medication for this disease, suppressing abnormal electrical activity in the nerves. The dose of the medication is gradually increased under a doctor's supervision. However, over time, the drug's effectiveness may decrease, or side effects such as dizziness and elevated liver enzymes may occur. In this case, different drug combinations can be tried.

Trigeminal Neuralgia Surgery and Interventional Methods

In situations where medication treatment is insufficient or cannot be used due to side effects, surgical interventions come to the forefront. The main methods applied are:

• Microvascular Decompression (MVD): This is the first method that comes to mind when mentioning trigeminal neuralgia surgery and has the highest success rate. The skull is accessed through a small incision behind the ear, the vessel pressing on the nerve is found, and a Teflon sponge is placed between the nerve and the vessel to cut off contact. It is a permanent approach that solves the pain at its source.
• Percutaneous Procedures: This involves entering through the cheek area with a needle and destroying the pain-transmitting fibres of the nerve in a controlled manner. It can be applied as radiofrequency rhizotomy (with heat), balloon compression (with mechanical pressure), or glycerol injection (chemically). These are generally shorter procedures that do not require general anaesthesia.
• Stereotactic Radiosurgery (Gamma Knife): This is the process of delivering a high dose of focused radiation to the point where the nerve enters the brainstem without making a surgical incision. The radiation slowly creates damage to the nerve, stopping the transmission of pain signals. Its effect usually appears within a few weeks or months.

The Disease's Effects on Daily Life and Complications

Trigeminal neuralgia does not only cause physical pain but also deeply shakes the patient's psychology and social life. The uncertainty of when the attacks will come creates a constant state of fear and anxiety in the person. The fear that eating will trigger the pain can lead patients to refuse nutrition and cause severe weight loss. Similarly, avoiding brushing teeth leads to the deterioration of oral and dental health.

Enduring constant pain and living in anticipation of pain brings along psychological complications such as severe depression, anxiety disorders, and social isolation in untreated cases. Some patients may experience pain-free remission (wellness) periods lasting weeks or months, but the pain usually returns. Therefore, keeping the disease under control is of critical importance in terms of preserving the quality of life.

When to See a Doctor?

If you feel sudden and very severe pains in your face that you have never experienced before, even if they are short-lived, you should consult a specialist without wasting time. Facial pains that do not respond to painkillers and restrict your daily activities should be taken seriously. If you experience any of the following symptoms, you should go to the nearest emergency department or call 112:

• Sudden facial paralysis or drooping accompanying facial pain,
• Speech impairment, inability to string words together,
• Sudden loss of strength or numbness in the arms or legs,
• Severe dizziness, loss of balance, or double vision,
• Confusion or a severe and sudden-onset headache.

These symptoms may be the harbinger of a neurological condition requiring emergency intervention, such as a stroke, rather than trigeminal neuralgia.

Trigeminal Neuralgia Diagnosis and Treatment Process at BHT CLINIC

At our BHT CLINIC İstanbul Tema Hastanesi Neurosurgery department, the diagnosis and treatment of trigeminal neuralgia are meticulously carried out by our expert medical staff. Our patients' complaints are evaluated with a multidisciplinary approach; the neurology, neurosurgery, and radiology departments work in coordination to create the most accurate treatment plan. Thanks to our advanced technology MRI devices, nerve compressions are detected with millimetric precision.

For our patients who do not respond to medication, microvascular decompression and other interventional pain treatments are safely performed in our operating theatres equipped to international standards. Our emergency department, providing uninterrupted service 24/7, is always ready for our patients experiencing severe pain crises. To start your diagnosis and treatment process and consult with our expert doctors, you can easily complete your transaction through our appointment page.

Frequently Asked Questions

How long do trigeminal neuralgia attacks last?

Attacks generally last between a few seconds and two minutes. However, these short-lived attacks can repeat tens or even hundreds of times during the day. In some patients, attacks occur in clusters that continue for weeks or months.

Does trigeminal neuralgia go away on its own?

The disease can sometimes enter remission (silent) periods that can last for months or years, and the pains may feel as if they have completely disappeared. However, because trigeminal neuralgia is caused by a structural problem, it generally does not heal completely on its own, and the pains return after a while.

How is trigeminal neuralgia distinguished from a toothache?

Because trigeminal neuralgia pain is generally felt in the jaw and tooth area, it is frequently confused with dental problems. While a toothache is more constant, throbbing, and localised; neuralgia pain has a sudden, very severe, and spreading character like an electric shock. Neurological evaluation is essential for pains that do not resolve despite dental treatments.

Is trigeminal neuralgia surgery risky?

Although every surgical intervention carries certain risks, microvascular decompression (MVD) is a highly safe surgery with a high success rate when performed by experienced neurosurgeons. Risks such as hearing loss or facial numbness after surgery have been minimised thanks to modern surgical microscopes.

Is there an herbal or natural treatment for the disease?

There is no proven herbal or natural treatment for trigeminal neuralgia. Since the source of the pain is physical nerve compression or damage, it is not possible to provide a permanent solution other than medical drugs or surgical methods. Resorting to alternative methods without a doctor's approval can lead to a waste of time and an exacerbation of the pain.

This article is for informational purposes only; always consult your doctor for diagnosis and treatment.