As I sat in the midst of a group of folks pleasantly chatting at a friend’s surprise birthday party, I couldn’t help noticing the grimaces of a woman across from me. Every minute or two she would wince as though being jabbed with a needle. When I asked about this privately she filled me in. “Since this morning it feels like every couple of minutes or so I get a really sharp, excruciating stab of pain near my left ear. It lasts just a couple of seconds but they’re so frequent its wearing me out.”
This lady was describing a somewhat uncommon, but extremely painful condition called trigeminal neuralgia (TN), or less commonly, tic douloureux (which just means “painful spasm”).
TN is a jolting jab of pain along one of the five branches of the trigeminal nerve. The trigeminal nerve is the main nerve of sensation for the face and part of the scalp. Most of the time the cause of the nerve malfunction is unknown and there is no simple blood test or imaging study to diagnose this. But the symptom is quite characteristic and usually makes the diagnosis clear.
TN has been described for well over 300 years and surgical treatments for it began over a century ago. In fact a first century Greek physician, Aretaeus of Cappadocia is thought to have been referring to TN when he described a headache in which “spasms and distortions of the countenance took place.”
The frequency of TN is only about 1.5 cases per 10,000 people per year. It occurs primarily in the middle-aged to elderly population, rarely occurring before age 40. The relative rarity of TN is a good thing as it can become so severe in some cases that, if not treated, it has pushed patients to the brink of suicide. The agonizing jabs of pain can occur anywhere from once every couple of days to hundreds of times per day. Most commonly they shoot from the corner of the mouth to the angle of the jaw. But they can also shoot from the area around the upper canine teeth toward the eyebrow.
So, what can be done about this agonizing malady if it strikes? Fortunately, there are some fairly effective treatments. For starters, certain medicines like Tegretol, gabapentin and Lyrica have shown benefit. Other meds can be used as add-ons if needed. These can give desperately needed relief. The course of TN is quite variable. So sometimes, if one of these meds can help in the short run, the pains dissipate over a few months and the person can go off the meds and do well. But in a majority of cases the pain returns at some point and it is not uncommon for the meds to begin to lose their effectiveness.
In more stubborn cases, certain surgical procedures can be effective, such as a procedure where pressure is taken off of the afflicting nerve branch. Obviously TN is no picnic to go through. But at least there are a few fairly effective options that weren’t around when Aretaeus observed his patient with “spasms and distortions of the countenance.”
Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville. He is contracted with some commercial insurance carriers and sees Direct Primary Care patients who do not have insurance, who belong to a cost sharing ministry, or who are on Medicare. He is accepting new patients. You may contact him at 982-0835