INFORMATION ON TIC DOULOUREUX

Tic douloureux, also known as trigeminal neuralgia, is a painful disorder of a nerve in the face called the trigeminal nerve or fifth cranial nerve. There are two trigeminal nerves, one on each side of the face. These nerves are responsible for detecting touch, pain, temperature and pressure sensations in areas of the face between the jaw and forehead. It stems from one or more branches of the nerve that supplies sensation to the face, the trigeminal nerve. It is considered one of the most painful conditions to affect people. Although a flurry of attacks can last for weeks or months, there are usually periods of months or even years that are symptom-free. The pain of tic douloureux is usually controlled with medications or surgery. Tic douloureux is generally a disease of middle age or later life. Women are affected more often than men. People with multiple sclerosis are affected much more frequently than the general population.

SYNONYMS OF TIC DOULOUREUX

1. Fothergill Disease
2. Trifacial Neuralgia

CAUSES OF TIC DOULOUREUX

Tic douloureux is not fully understood, but in the vast majority of cases, it appears to be caused by irritation or compression of a trigeminal nerve, generally from a vessel banging into the nerve. Other causes are quite rare.The irritation is believed to be caused by an abnormal blood vessel pressing on the nerve.

SYMPTOMS OF TIC DOULOUREUX

1. There may be a tearing pain, darting, or sharp cutting sensation that occurs in a portion of the face, typically on one side.
2. Often, there are trigger zones - spots on the face or certain movements - that precipitate the pain. These may include smiling, talking, chewing, brushing one's teeth, or blowing the nose.
3. The pain comes in intermittent episodes that last from a few seconds to a few minutes. There may be many episodes of pain per day. There is no pain between episodes.
4. The flurry of pain episodes may last from a few weeks to a few months, followed by pain-free periods of months to even years. Generally, the episodes become more frequent and more resistant to treatment with medications over time.

DIAGNOSIS OF TIC DOULOUREUX

Diagnosis is based on the symptoms. In a young patient with trigeminal neuralgia, multiple sclerosis is suspected even if there are no other Neurologic signs.
To help rule out medical and dental conditions that can have similar symptoms, your doctor also will ask whether you have a history of:
Recent trauma to your face or teeth
A recent tooth infection or root canal treatment
A tooth extraction on the same side as your facial pain — Sometimes a tooth extraction can cause pain in the area of the missing tooth.
Next, your doctor will thoroughly examine your head and neck, including the area inside your mouth. The doctor also will do a brief neurological examination and concentrate on feeling and muscle movements in your face.

If necessary, your doctor will order a magnetic resonance imaging (MRI) or computed tomography (CT) scan of your head to check for blood vessel abnormalities, tumors pressing on your trigeminal nerve or other possible causes of your symptoms.

TREATMENT OF TIC DOULOUREUX

1. The primary treatment of tic douloureux is medication to control the pain. Surgery may be necessary when drug therapy is not effective or side effects from the medications are not tolerable.
2. If drug treatments fail to control the discomfort, nerve blocks or surgical procedures to reduce the sensitivity of the nerve are an option.
3. An operation to free the nerve from the blood vessel or tumor compressing it also can eliminate the pain permanently.
4. Gamma radiotherapy to the trigeminal root is a noninvasive method that may be successful. Symptomatic relief may also be obtained from radiofrequency rhizotomy, another noninvasive treatment.