OVERVIEW OF THE DISEASE

Definition
Trigeminal neuralgia (TN) is a condition characterized by pain coming
from the trigeminal nerve, which starts near the top of the ear and splits in
three, toward the eye, cheek and jaw. We have two trigeminal nerves: one for
each side of our face, but trigeminal neuralgia pain most commonly affects
only one side but can occur bilaterally (on both sides) as well.

Trigeminal neuralgia is a type of neuropathic (nerve related) pain that stems

from the trigeminal nerve. This nerve has three branches that bring sensation
to different parts of the face. These include:

1. Upper: Controls sensation in the eye, upper eyelid, and forehead

2. Medial: Sensation control in the lower eyelid, cheek, nostril, upper lip,
and upper gum
3. Lower: Responsible for feeling in the jaw, lower lip, lower gum, and
inside the mouth

Typical (Type 1) trigeminal neuralgia. You’ll likely experience painful

episodes that are sharp, intense and sporadic. You may feel pain and/or a
burning sensation all over your face that can last anywhere from a few seconds
to two minutes. Though there will be pain-free breaks in between episodes, this
can continue for up to two hours. This type of neuralgia is known as idiopathic

Typical (Type 2) trigeminal neuralgia. This will be less painful and

intense but more widespread. You’ll likely feel constant pain, notably stabbing
and/or burning sensations, along with persistent aches and pains. With atypical
trigeminal neuralgia, you may have more difficulty controlling the symptoms.

Symptomatic trigeminal neuralgia (STN) is when pain results from an

underlying cause, such as multiple sclerosis

The pain of trigeminal neuralgia is unlike facial pain caused by other

problems. It is often described as stabbing, lancinating or electrical in
sensation and so severe that the affected person cannot eat or drink. The
pain travels through the face in a matter of seconds, but as the condition
progresses, the pain can last minutes and even longer.

Trigeminal neuralgia is sometimes known as tic douloureux, which

means "painful tic."
Risk Factors

Age and gender are primary risk factors, as women over the age of 50 are
most likely to develop this condition. Hypertension (high blood pressure) is
also a risk factor, as is the occurrence of a stroke.

Excessive or improper dental work can cause neuropathic facial pain, as can
surgery on the sinuses.

Finally, any blow or injury to the face (i.e., as a result of a contact sport injury)
is a risk factor for trigeminal neuralgia.

Causes

 Damage to the trigeminal nerve: Any kind of blow or injury to the

jaw can potentially damage the trigeminal nerve. This damage can
cause excruciating pain while the injury heals.
 Nerve compression: Nerve compression caused by a tumor or
other mass of tissue is not the most common cause but does occur in
some patients. Tumors can be benign and still press on the nerve,
causing pain.
 Multiple sclerosis: Multiple sclerosis causes damage to the myelin
sheath, the protective coating on the trigeminal nerve. Once this sheath
is compromised or worn, exposing the nerve, pain can occur.
 Scleroderma: Scleroderma is a very rare chronic connective tissue
disorder that is classified as an autoimmune condition. Among other
symptoms, trigeminal pain can occur in later stages.
 Shingles (herpes zoster): Shingles is a viral infection of the
nerves. Common symptoms include a raised, painful rash and, less
typically, trigeminal neuralgia pain. Trigeminal pain generally occurs
when the shingles rash in located near or on the head, face, or neck.
 Deformity in the arteries and veins: Tangled arteries and veins
that become swollen with blood can compress the trigeminal nerve.

Signs and Symptoms

Trigeminal neuralgia symptoms may include one or more of these patterns:

 Episodes of severe, shooting or jabbing pain that may feel like an electric
shock
 Spontaneous attacks of pain or attacks triggered by things such as
touching the face, chewing, speaking or brushing teeth
 Attacks of pain lasting from a few seconds to several minutes
 Pain that occurs with facial spasms
 Bouts of multiple attacks lasting days, weeks, months or longer — some
people have periods when they experience no pain
 Pain in areas supplied by the trigeminal nerve, including the cheek, jaw,
teeth, gums, lips, or less often the eye and forehead
 Pain affecting one side of the face at a time
 Pain focused in one spot or spread in a wider pattern
 Pain rarely occurring at night while sleeping
 Attacks that become more frequent and intense over time

Prevention

No one can prevent the Trigeminal neuralgia but we can prevent the attacks
by:

 Eating soft foods and avoiding hard and crunchy foods

 Avoiding too hot or too cold drinks
 Washing face with lukewarm water and wiping with cotton pads
 If brushing your teeth triggers an attack gently rinse your mouth after
eating
 Chew your food and swallow slowly
 Avoiding talking on mobile phone for hours together as the phone gets
heated up and radiations also may provoke the pain to increase.

Avoid or minimize known triggers. Such as:

 Touching the face

 Talking
 Chewing
 Eating
 Tooth brushing
 Shaving
 Drinking
 Swallowing
 Washing the face
 Drying the face
 Jaw movement
 Blowing the nose
 Hot or cold food/ water

Complications

The main complication of trigeminal neuralgia is side effects and toxicity from
long-term use of anticonvulsants. In addition, some anticonvulsants lose
 effectiveness over time and another anticonvulsant may be needed, which
increases the risk for drug-related adverse reactions.
There may be complications from surgical procedures used to treat trigeminal
neuralgia, such as:
 loss of sensation of a portion of the face or mouth
 jaw weakness
 eye numbness
 corneal ulceration
 reactivation of a herpes simplex infection
 lack of relief from the procedure
 short-term relief (1-2 years) from the procedure, requiring a second
operation
 damage to the nerve which results in a permanent numbness of the face
accompanied by pain (anesthesia dolorosa)

Diagnostic:

 A neurological examination. Touching and examining parts of your

face can help your doctor determine exactly where the pain is occurring and
— if you appear to have trigeminal neuralgia — which branches of the
trigeminal nerve may be affected. Reflex tests also can help your doctor
determine if your symptoms are caused by a compressed nerve or another
condition.
 Magnetic resonance imaging (MRI). Your doctor may order an MRI
scan of your head to determine if multiple sclerosis or a tumor is causing
trigeminal neuralgia. In some cases, your doctor may inject a dye into a
blood vessel to view the arteries and veins and highlight blood flow
(magnetic resonance angiogram).

Medical Management

 The anticonvulsant carbamazepine is the first line treatment, second

line medications include baclofen, lamotrigine, oxcarbazepine, phenytoin,
gabapentin, pregabalin, and sodium valproate
 Low doses of some antidepressants such as amitriptyline are
thought to be effective in treating neuropathic pain
 Duloxetine can also be used in some cases of neuropathic pain, and as it
is also an antidepressant can be particularly helpful where neuropathic pain
and depression are combined.
 Opiates such as morphine and oxycodone can be prescribed, and there is
evidence of their effectiveness on neuropathic pain, especially if combined
with gabapentin
 Gallium maltolate in a cream or ointment base has been reported to
relieve refractory postherpetic trigeminal neuralgia

Deep Brain Stimulation

It involves delivering and electrical pulse to a part of the brain using a probe.
A scanning technique (usually MRI or CT) is used to make sure the probe is in
the right place

Surgical Management
Surgical options for trigeminal neuralgia include:

Microvascular decompression. This procedure involves relocating

or removing blood vessels that are in contact with the trigeminal root to
stop the nerve from malfunctioning.

Brain stereotactic radiosurgery (Gamma knife). In this

procedure, a surgeon directs a focused dose of radiation to the root of
your trigeminal nerve. This procedure uses radiation to damage the
trigeminal nerve and reduce or eliminate pain. Relief occurs gradually and
may take up to a month.

Rhizotomy. In a rhizotomy, your surgeon destroys nerve fibers to reduce

pain, and this causes some facial numbness. Types of rhizotomy
include:

Glycerol injection. During this procedure, your doctor inserts a needle

through your face and into an opening in the base of your skull. Your
doctor guides the needle into the trigeminal cistern, a small sac of spinal
fluid that surrounds the trigeminal nerve ganglion — where the trigeminal
nerve divides into three branches — and part of its root. Then, your doctor
will inject a small amount of sterile glycerol, which damages the trigeminal
nerve and blocks pain signals.
 Balloon compression. In balloon compression, your doctor inserts a
hollow needle through your face and guides it to a part of your trigeminal
nerve that goes through the base of your skull. Then, your doctor threads
a thin, flexible tube (catheter) with a balloon on the end through the
needle. Your doctor inflates the balloon with enough pressure to damage
the trigeminal nerve and block pain signals.

Radiofrequency thermal lesioning. This procedure selectively

destroys nerve fibers associated with pain.

NURSING MANAGEMENT

 Instruct the client to avoid factors that can trigger the attack and result in
exhaustion and fatigue
 Avoid foods that are too cold or too hot
 Chew foods in the affected side
 Use cotton pads gently, wash face and for oral hygiene
 Provide teaching to clients who have sensory loss as a result of a treatment
 Inspection of the eye for foreign bodies, which the client will not be able to
feel, should be done several times a day
 Warm normal saline irrigation of the affected eye two or three times a day is
helpful in preventing corneal infection
 Dental checkup every 6 months is encouraged, since dental caries will not
produce pain
 Explain to the client and his family the disease and its treatments

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https://www.mayoclinic.org/diseases-conditions/trigeminal-neuralgia/symptoms-causes/syc-20353344

Trigeminal Neuralgia. (n.d.). Www.hopkinsmedicine.org. https://www.hopkinsmedicine.org/health/conditions-and-

diseases/trigeminal-neuralgia

Trigeminal Neuralgia: Types, Causes, Treatments. (n.d.). Cleveland Clinic.

https://my.clevelandclinic.org/health/diseases/15671-trigeminal-neuralgia-tn