Tic Douloureux

Tic douloureux, also known as trigeminal neuralgia, is a chronic facial pain condition known for its excruciating intensity. It affects the trigeminal nerve, which is responsible for feeling in your face. Patients with tic douloureux often describe the pain as unbearable or torturous.

Who Gets Tic Douloureux?

Tic douloureux strikes middle-aged and older adults more frequently, with women being slightly more susceptible than men. People with multiple sclerosis are also more susceptible to this condition.

Symptoms to Watch For:

• Sudden, sharp, electric shock-like pain on one side of the face, usually lasting seconds to minutes.
• Lower face pain is most common, affecting the jaw, cheek, or lip.
• Trigger points on the face or mouth can initiate pain attacks with a light touch.
• Talking, eating, or brushing teeth may trigger pain episodes.
• Periods of pain may alternate with pain-free intervals lasting months or even years.

What Causes It?

The exact cause is unknown, but theories suggest:

• Compression of the trigeminal nerve (the nerve responsible for facial sensation) by a blood vessel.
• Damage to the nerve’s protective sheath, causing it to misfire pain signals.
• Tumors or skull abnormalities are pressing on the nerve.
• Trauma, infections, or multiple sclerosis can also play a role.

What triggers the pain?

Even the gentlest touches to your face can trigger the pain, including talking, eating, or brushing your teeth. Even cool air can sometimes set it off. These “trigger points” are usually not in the same location as the pain itself.

Seeking medical help

• If prescribed medications aren’t controlling your pain or you develop new symptoms, see your doctor.
• Go to the emergency room for fever, facial redness, or dizziness, as these could signal other issues.

Diagnosis

There’s no single test for tic-douloureux. Diagnosis is based on the following procedures:

• Description of Pain: Patients describe their symptoms, including sudden bursts of shooting pain on one side of the face and any identifiable trigger zones.
• Physical Examination: Your doctor will give your face a thorough check-up to assess your facial muscles and how well you feel things. Normal findings on physical examination are typical for tic douloureux. However, the presence of symptoms such as numbness, decreased hearing, dizziness, visual changes, or facial muscle dysfunction may warrant further evaluation for alternative diagnoses.
• Exclusion of Other Causes: Other potential causes of facial pain, such as sinus infections, dental infections, or temporomandibular joint (TMJ) disorders, are ruled out through physical examination and medical history assessment.
• Specialized Imaging: Special X-ray images, such as CT scans or MRIs of the head, may be performed to visualize the structures of the head and face. These imaging studies help identify any structural abnormalities, including tumors or vascular compression of the trigeminal nerve, which could contribute to facial pain. They also assist in delineating blood vessels or tumors that may be impinging on the nerve and causing irritation.

Treatment Options

• Medications: Medications, typically anticonvulsants, aim to stabilize the irritated nerve and prevent pain signals. Carbamazepine is a common first-line medication, but others like gabapentin and lamotrigine are also used. These medications can cause side effects like drowsiness, dizziness, or nausea. Botox injections have emerged as a promising treatment, offering significant pain relief for some patients. Opioid pain medications can also be used for severe pain episodes.
• Surgery: Surgery may be considered if medication fails or has intolerable side effects. Options range from nerve injections to complex procedures with varying levels of pain relief and complication risks. Generally, the more complex the surgery, the longer the pain relief may last, but there’s also a higher risk of complications.

Living with Tic Douloureux

• While there’s no cure, the pain can be effectively managed with medication or surgery in most cases.
• Follow-up appointments are crucial to monitor medication effects and adjust treatment as needed.
• Despite the pain, most people with tic douloureux can live fulfilling lives.

Sources

• National Institute of Neurological Disorders and Stroke (https://www.ncbi.nlm.nih.gov/books/NBK554486/)
• American Academy of Neurology (https://www.aan.com/)
• eMedicineHealth: “Tic Douloureux.”
• UpToDate: “Trigeminal neuralgia.”
• University of San Francisco Medical Center: “Medical Therapy for Trigeminal Neuralgia.”