Trigeminal neuralgia (TN), also known as tic douloureux, is a type of chronic pain disorder that involves sudden attacks of severe facial pain. It affects the trigeminal nerve (the fifth cranial nerve) which provides feeling and nerve signaling to parts of the head and face. TN is a type of neuropathic pain, sometimes caused by an injury or nerve lesion.
Pain attacks last a few seconds (but can last up to two minutes) and may occur over and over again several times a day, but sometimes it lasts for a day or more. The pain typically affects one side of the face, including areas such as the cheek, jaw, teeth, gums, and sometimes the forehead and eye.
TN occurs most often in people over age 50, although it can occur at any age, including infancy. The disorder is more common in women than in men.
Types of trigeminal neuralgia
Types of trigeminal neuralgia are categorized based on the cause:
Classic: This is the most common form, in which a blood vessel (usually the superior cerebellar artery) is found to be pushing on part of the trigeminal nerve root.
Secondary: In these cases, TN is caused by another disorder (such as multiple sclerosis, a tumor, or arteriovenous malformation). Individuals with secondary TN are more likely to be younger and to have pain on both sides of the face. Only 15% of TN cases are secondary.
When no clear cause can be found even after a diagnostic workup (evaluation), it is considered idiopathic TN. This is the least common type of TN.
Symptoms of trigeminal neuralgia
Symptoms of TN include:
Sudden, intense pain, often described as a shock-like or stabbing pain typically on one side of the face. Burning, throbbing, numbness, tingling, or dull aching sensation in between attacks. In some cases, trigeminal neuralgia can worsen over time, leading to longer and more frequent pain attacks.
The intensity of pain can be physically and emotionally devastating. TN attacks typically stop for a period of time and then return. Pain attacks can be triggered by vibration or contact with the cheek (such as when shaving, washing the face, or applying makeup), teeth brushing, nose blowing, eating, drinking, talking, noise or being exposed to the wind. The pain may affect a small area of the face, or it may spread. The pain rarely occurs during sleep.
In some cases, the condition can be progressive, meaning that the attacks can get worse over time, with longer and more frequent episodes. Patient may feel pain all the time. In many such cases, allopathic medication to control the pain also becomes less effective over time.
What are the trigeminal nerves and how do they work?
The trigeminal nerves are a pair of cranial nerves that connect the brain and brain stem to different parts of the face. The trigeminal nerves have three branches that send and receive sensations from the upper, middle, and lower portions of the face.
- The ophthalmic (upper) branch supplies sensation to most of the scalp, forehead, and front of the head.
- The maxillary (middle) branch supplies sensation to the cheek, upper jaw, top lip, teeth and gums, and side of the nose.
- The mandibular (lower) branch supplies nerves to the lower jaw, teeth and gums, and bottom lip. 

More than one nerve branch can be affected by TN, but the maxillary or mandibular branches are the most commonly affected. When the ophthalmic branch is affected, redness or unexplained tears in the eyes may also occur at the same time as pain attacks. In rare cases, both sides of the face may be affected at different times, or even at the same time; this is called bilateral TN.
How is trigeminal neuralgia diagnosed?
Diagnosing trigeminal neuralgia
A doctor will conduct a physical examination, review the person’s full medical history, and consider their symptoms when diagnosing TN. A workup usually includes a neurological examination and imaging with MRI (magnetic resonance imaging) to look for structural abnormalities (such as compression of the trigeminal nerve) or other disorders that could cause facial pain.
Treating trigeminal neuralgia with allopathy
Generally, the first line of allopathic treatment for people living with TN is allopathic medication, but allopathic medication is unable to relieve pain or produces intolerable side effects. Allopath usually advise surgery. In some cases, complementary approaches, usually combined with medications, may help manage TN but chances are very low.
Allopathic medications for trigeminal neuralgia
📢 Note: TN is a progressive disorder that becomes resistant to allopathic medication over time.
There are several types of allopathic medication that can help TN:
- Anticonvulsant medicines, which are used to temporary block pain signals, it can reduce the frequency of attacks. These drugs include carbamazepine, oxcarbazepine, gabapentin, pregabalin, lamotrigine, topiramate, or phenytoin. If a single drug fails to improve symptoms, more than one drug may be used at the same time.
- Other medications may be tried, particularly if anticonvulsants are not effective (their side effects are too bothersome). These drugs include baclofen and Botulinum toxin A.
Common allopathic pain-relieving medications (such as aspirin and ibuprofen) and opioid medications such as hydrocodone are not usually helpful in treating TN.
Surgery for trigeminal neuralgia
If medication fails to relieve pain or produces intolerable side effects such as cognitive disturbances, memory loss, excess fatigue, bone marrow suppression, or allergy, the allopathic doctors recommend surgical treatment. With allopathic doctors, surgery is a common approach for almost all diseases.
Several neurosurgical procedures are available to treat TN. The choice of procedure depends on:
- The nature of the pain,
- The person’s preference, physical health, blood pressure, and previous surgeries,
- The presence or absence of multiple sclerosis,
- Which trigeminal nerve is most affected (particularly when the upper/ophthalmic branch is involved).
Microvascular decompression
MVD is the most invasive surgery for TN. It is also the most effective at preventing pain long-term. MVD involves relieving pressure from surrounding blood vessels that either wrap the nerve or are touching it. Unlike rhizotomies (described below), the goal is not to produce numbness in the face after this surgery. 
Rhizotomy (rhizolysis)
This is a procedure in which nerve fibers are damaged in order to block pain. People who use a rhizotomy for TN always experience some degree of sensory loss and facial numbness. There are several different forms of rhizotomy used to treat TN, including balloon compression, glycerol injection, radiofrequency thermal lesioning, and stereotactic radiosurgery. These surgeries may relieve pain for a few years but are less effective long term.
Radiosurgery
In this procedure doctor’s aims is to focused radiation on damaged nerve fibers from the trigeminal nerve close to where it is connected to the brainstem. Unlike other surgical procedures, pain relief resulting from this procedure may take over a month to develop.
Side effects of surgery
Facial numbness may occur after many of these surgical procedures, and TN will often return even if the surgery is initially successful. Depending on the procedure, these include hearing loss, balance problems, leaking of the cerebrospinal fluid, infection, anesthesia dolorosa (persistent intense pain in the face or mouth), and sometimes stroke.
Homeopathic treatments for trigeminal neuralgia
There are many medicines for neuralgias or nerve’s pains in Homeopathy, here are few of them:
P. S: This article is only for doctors and students having good knowledge about Homeopathy and allopathy.

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Dr. Sayyad Qaisar Ahmed (MD {Ukraine}, DHMS), Abdominal Surgeries, Oncological surgeries, Gastroenterologist, Specialist Homeopathic Medicines.
Senior research officer at Dnepropetrovsk state medical academy Ukraine.
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