Trigeminal neuralgia (tic douloureux) is a disorder of the fifth cranial (trigeminal) nerve that causes episodes of intense, stabbing, electric shock-like pain in the areas of the face where the branches of the nerve are distributed – lips, eyes, nose, scalp, forehead, upper jaw, and lower jaw.

Classic symptoms of Trigeminal Neuralgia include:

  • Pain is described as lancinating – (sharp)
  • Pain comes and goes (intermittent)
  • Pain must be in the distribution of the trigeminal nerve
  • There has to be triggers
  • There is remission
  • A diagnostic tool is the response to Tegretol (Carbamazepine)

Trigeminal nerve – (V) fifth cranial nerve

V1: Ophtalmic-eye, forehead and nose.1-Sensory
V2: Maxillary – upper teeth, gums and lip, the cheek, lower eyelid and the side of the nose.1-Sensory
V3: Mandibular – lower teeth, lower gums and lower lip1-Sensory   Jaw2-Motor

1SENSORY: Transmits pressure, touch, pain and temperature signals to the brain.
2MOTOR: Controls movement.

Trigeminal Neuralgia pain can involve one or more branches of the trigeminal nerve.

A valuable clue to the diagnosis is the triggering of the pain with certain activities. Patients carefully avoid rubbing the face or shaving a trigger area.

Chewing, talking, smiling, or drinking cold or hot fluids may trigger Trigeminal Neuralgia pain. Touching, shaving, brushing teeth, blowing the nose, or cold/warm breeze also may bring on an attack.

Although thin cut, 3-D volume acquisition MRI may detect vascular compression, the scan/imaging is not a diagnostic tool for TN.