Also called TIC DOULOUREUX, this is one of the most severe forms of NEURALGIA. It affects the main sensory nerve in the face (TRIGEMINAL NERVE) and is usually confined to one side. Attacks are often precipitated by movements of the jaw, as in talking or eating, or by a cold wind or washing the face. When the first or upper division of the nerve is involved, the pain is mostly felt in the forehead and side of the head. It is usually of an intensely sharp, cutting, or burning character, either constant or with exacerbations each day while the attack continues. There is also pain in the eyelid, redness of the eye and increased flow of tears. When the second division of the nerve is affected, the pain is chiefly in the cheek and upper jaw. When the third division of the nerve suffers, the pain affects the lower jaw. Attacks may recur for years and interfere with sleeping and eating, sometimes being intolerable.
The pain may be relieved by CARBAMAZEPINE. If its unwanted effects – for example, dizziness, headache, nausea or drowsiness – are unacceptable or pain not relieved, PHENYTOIN SODIUM may help, as may other ANTICONVULSANTS or MUSCLE RELAXANTS such as baclofen. Alcohol injections into the area of the face corresponding to the course of the nerve may relieve attacks temporarily. Microvascular decompression surgery may be needed to separate blood vessels in contact with the root of the trigeminal nerve. The success rate is high but there are certain risks, which need to be discussed with the neurosurgeon who is to conduct surgery. Other procedures include glycerol injection at the point where the nerve divides into its branches; balloon compression of the nerve; controlled, radiofrequency application, radiating or severing the nerve. All of these carry the risk of resulting facial numbness.