Symptoms and Signs of Tic Douloureux (Trigeminal Neuralgia)

Doctor's Notes on Tic Douloureux (Trigeminal Neuralgia)

Tic douloureux (trigeminal neuralgia) is a severe, stabbing pain to one side of the face, typically in the jaw, cheek, or lip. It stems from one or more branches of the trigeminal nerve that supplies sensation to the face. 

The main symptom of tic douloureux is a sudden, severe, stabbing, sharp, shooting, electric-shock-like pain on one side of the face, usually in the lower half of the face.

• The pain is intermittent and lasts from a few seconds to a few minutes and is so severe people may become afraid to talk, eat, or move during periods of attacks.
• The attacks of pain are often triggered by physical stimulation of a trigger point on the same side of the face as the pain.
• Talking, eating, brushing the teeth, or even cool air on the face may trigger the pain.

There may be several episodes of pain per day and there is no pain between episodes. Pain episodes may last from a few weeks to a few months, followed by pain-free periods of months to years. Pain episodes often become more frequent and more resistant to treatment with medications over time.

What Is the Treatment for Tic Douloureux (Trigeminal Neuralgia)?

Treatment for trigeminal neuralgia (tic douloureux) depends on the patient's age and overall health. Medications are effective in about 75% of patients and include:

• Antiepileptic drugs (AEDs) 
  • Carbamazepine (Tegretol XR) 
  • Valproate (Depacon)
  • Clonazepam (Klonopin) 
  • Lamotrigine (Lamictal) 
  • Gabapentin (Neurontin)
• Antispasmodic agents such as baclofen (Gablofen, Lioresal) and tizanidine (Zanaflex)
• Other medications: 
  • Pimozide (Orap), a dopamine receptor antagonist, was more effective than carbamazepine in one trial but is seldom used for TN because it has many potentially serious side effects
  • Topical lidocaine given by intraoral application for pain reduction 
  • Botulinum toxin injections may be beneficial

Patients with trigeminal neuralgia may also have accompanying depression, and may require antidepressant therapy.

Patients who do not respond to medical treatments may require surgery to treat trigeminal neuralgia. The types of surgeries include:

• Microvascular decompression for TN caused by compression of the trigeminal nerve root
• Ablative procedures
  • These procedures burn or freeze tissue
    • Rhizotomy with radiofrequency thermocoagulation, mechanical balloon compression, or chemical (glycerol) injection
    • Radiosurgery
    • Peripheral neurectomy and nerve block

Transcranial magnetic stimulation may also be of benefit in TN.