Trigeminal Neuralgia - Signs and Symptoms

Signs and Symptoms

This disorder is characterized by episodes of intense facial pain that last from a few seconds to several minutes or hours. The episodes of intense pain may occur paroxysmally. To describe the pain sensation, patients may describe a trigger area on the face so sensitive that touching or even air currents can trigger an episode; however, in many patients the pain is generated spontaneously without any apparent stimulation. It affects lifestyle as it can be triggered by common activities such as eating, talking, shaving and brushing teeth. Wind, high pitched sounds, loud noises such as concerts or crowds, chewing, and talking can aggravate the condition in many patients. The attacks are said by those affected to feel like stabbing electric shocks, burning, pressing, crushing, exploding or shooting pain that becomes intractable.

Individual attacks usually affect one side of the face at a time, lasting from several seconds to a few minutes and repeat up to hundreds of times throughout the day. The pain also tends to occur in cycles with remissions lasting months or even years. 10-12% of cases are bilateral, or occurring on both sides. This normally indicates problems with both trigeminal nerves since one serves strictly the left side of the face and the other serves the right side. Pain attacks are known to worsen in frequency or severity over time, in some patients. Many patients develop the pain in one branch, then over years the pain will travel through the other nerve branches. Some patients also experience pain in the index finger.

It may slowly spread to involve more extensive portions of the trigeminal nerve. The spread may even affect all divisions of the nerve, and sometimes simultaneously. Cases with bilateral involvement have not indicated simultaneous activity. The following suggest a systemic development: rapid spreading, bilateral involvement, or simultaneous participation with other major nerve trunks. Examples of systemic involvement include multiple sclerosis or expanding cranial tumor. Examples of simultaneous involvement include tic convulsive (of the fifth and seventh cranial nerves) and occurrence of symptoms in the fifth and ninth cranial nerve areas.

Outwardly visible signs of TN can sometimes be seen in males who may deliberately miss an area of their face when shaving, in order to avoid triggering an episode. Successive recurrences are incapacitating and the dread of provoking an attack may make sufferers unable to engage in normal daily activities.

There is also a variant of TN called atypical trigeminal neuralgia (also referred to as "trigeminal neuralgia, type 2"), based on a recent classification of facial pain. In some cases of atypical TN the sufferer experiences a severe, relentless underlying pain similar to a migraine in addition to the stabbing shock-like pains. In other cases, the pain is stabbing and intense but may feel like burning or prickling, rather than a shock. Sometimes the pain is a combination of shock-like sensations, migraine-like pain, and burning or prickling pain. It can also manifest as an unrelenting, boring, piercing pain.