The trigeminal nerve is the nerve responsible for sensation in the face and motor functions such as biting and chewing. It is the largest cranial nerve. Trigeminal neuralgia (TN) is a chronic pain disorder affecting this nerve, and it is thought that the cause is a loss of myelin around the nerve. Blood vessel compression may also be a cause, and TCIs, multiple sclerosis (MS), stroke and brain injuries may also cause TN.
TN is also known as tic douloureux, prosopalgia, Fothergill’s disease (after John Fothergill’s description of TN in 1773) and “suicide disease”, due to the high number of people who commit suicide due to TN, much in the same way that cluster headaches are sometimes called “suicide headaches”. 25% of people who suffer from TN commit suicide. The pain is excruciating, and is comparable to severe burns, giving birth and the bite of a bullet ant. Typically, the pain starts on one side of the face and moves to another, and can last anything from a few seconds to a few hours.
Medications usually prescribed for TN include antiepileptics/anticonvulsants such as carbamazepine, lamotrigine and oxcarbazepine (benzodiazepines), GABA agonists such as baclofen, and anticonvulsants such as gabapentin. Antipsychotics such as pimozide may also be used. Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as amitriptyline may also be used. Opioids are not recommended for TN and, as with many other types of nerve pain, will have little-to-no effect on reducing pain. Surgery is also an option, as is botox treatment. An estimated 1 in 8,000 people develop TN in a given year, with onset usually beginning after 50 years old. Those with conditions such as MS, AIDS/HIV and diabetes are more likely to develop TN.