Trigeminal neuralgia (TN), also known as tic douloureux, is a disorder of the fifth cranial nerve (trigeminal nerve). It is characterized by attacks of intense, stabbing pain affecting the mouth, cheek, nose, and other areas on one side of the face. Sometimes there's a constant dull aching or burning pain. Both types of pain can occur in the same individual, even at the same time. In some cases, the pain can be excruciating and disabling. If untreated, TN can have a profound effect on a person’s quality of life. In most cases, TN develops due to a blood vessel pressing against the trigeminal nerve, but sometimes no underlying cause can be identified (idiopathic). It can also be idiopathic, due to compression of the trigeminal nerve, or can occur due to a known underlying cause such as a tumor or multiple sclerosis. TN can usually be managed through medications, surgery or injections, or stereotactic radiosurgery.
Few notable persons with TN are
British Prime Minister William Gladstone. It is possible that Gladstone's symptoms of "neuralgia" and "headache" were indicative of a more serious condition, Trigeminal neuralgia. He displayed characteristic symptoms: intermittent pain at varying intervals including wind or cold.
Author Gloria Steinem had survived the pain of an illness that went too many months misdiagnosed by her doctors, an illness finally correctly diagnosed as trigeminal neuralgia.
Entrepreneur and author Melissa Seymour was diagnosed with TN in 2009 and underwent microvascular decompression surgery.
I was diagnosed with a condition called ‘Trigeminal Neuralgia’ and soon after underwent Neurosurgery to try and fix it. There is a very long story here but suffice to say, it wasn’t successful, and having contracted ‘Bacterial Meningitis’ in the hospital, well, you could say that things didn’t quite go according to plan and so a nightmare couple of years ensued (Brad –my husband – and I call those the Black Years.) About 18 months after that first surgery, I finally underwent another Neurosurgery operation, which was a great success, and after the three-month recovery phase, went about rebuilding my very broken-down life...she wrote
Salman Khan was successfully operated from Trigeminal Neuralgia in Los Angeles in 2011. He has been suffering from this pain for the past 7 years and was on medications. But from the past 3 months, the pain has become unbearable in his jaws and finally, he decided not to neglect it further and get treatment.
Trigeminal neuralgia affects the trigeminal nerve in the face and can be excruciatingly painful. What felt initially like an earache, one weekend around Halloween in 2012, just a few weeks after Donegal's All-Ireland success, developed into a condition so bad that there were times when Toye "didn't know whether to stand or sit" with the pain. At night he struggled to sleep, by day he struggled to work. Putting on the gear and going out for a run was out of the question. The slightest breeze could trigger that dull, aching sensation that just didn't leave him. All Ireland footballer Christy Toye" I thought it was an earache. I went to the doctor and didn't think much about it. But then it got progressively worse," he recalls.
It was a warm October morning and I was in a merry mood having a good time. I sat down with a book determined to enjoy it thoroughly but suddenly out of the blue something zapped across my right eye. The jolt of lightening appeared repeatedly. It lasted for a few seconds to a few minutes but it was difficult to keep my right eye open. This continued for the next few days but the pain was gone as abruptly as it appeared. I went to the neuro-ophthalmologist thinking about my optic nerve tumor but he said optic nerve doesn't cause pain and it looks like trigeminal neuralgia and I should visit my neurologist immediately. He did his examination and said it was TN and asked for an MRI. I underwent an MRI scan the next day and it confirmed the diagnosis of trigeminal neuralgia...“ Thin vascular loop of SCA abutting cranial aspect of the right trigeminal nerve at the root entry zone is noted.”
Contorted faces of men suffering from agonizing facial pain have been recorded historically. Greek and Roman physicians, who called it simply cephalalgia, meaning head pain. Persian physician, Avicenna, described it 900 years ago and even suggested that it might have something to do with an artery being near a nerve.
Branches of Trigeminal nerve
The mandibular branch( bottom) of the trigeminal nerve serves the lower jaw, including the lower teeth, lower lip, side, and front of the tongue, lower gums.
part of the ear.
The middle or maxillary branch serves the
the upper jaw, upper teeth, and gums, upper lip,
cheeks
palate
sinuses
temples, and most of the nose.
The upper or ophthalmic branch serves
the forehead, eyes
bridge of the nose.
There can be some overlap, especially in the eye itself.
The trigeminal nerves are responsible for the sensations of touch, temperature, and pain in most of the face. A separate branch of the trigeminal nerve also controls the muscles used in chewing.
The three main nerves come together in a ganglion (Greek ganglion ‘tumor on or near sinews or tendons,’). A ganglion is a collection of specialized cells linked by connection points [synapses] forming a swelling on a nerve fiber. This is the first neuron (primary neuron) in a pathway whose activity will eventually result in your awareness of being touched.
The nerve fibers and the nerve itself are sheathed by a fatty, protective substance called myelin.
The trigeminal nerves are responsible for almost all sensations from the forehead to the lower jaw, including heat, cold, pressure, touch, and, of course, pain. The right trigeminal nerve serves the entire right side of the face; the left one, the left side.
It is also known as"suicide disease” as a result of those who killed themselves to escape the pain.
One or both of the trigeminal nerves are misfiring, sending pain signals when they should not. Most of the time it is one trigeminal nerve, so it is one-sided. It is the loss of or damage to the nerve's protective coating, the myelin, is somehow related to the problem.
It's like in TN what happens is when a plugged-in electrical wire loses its insulation: When you touch with bare hands, they spark, short-circuit, and the wire stops working as it should. In TN, the damaged nerve fibers are like bare wires and light touch is the “movement” of the wire that sets off sparking and the short-circuiting.
Few doctors and nutritionists have proposed that lack of Vitamin B-12 and possibly other nutritional defects prevent the body from building the myelin. Vitamin B-12 shots or mega-doses plus other nutritional changes may stop the pain. B12 is a water-soluble vitamin that is an essential part of the building block process for myelin and may contribute in that regard. If damaged myelin is at the heart of the trigeminal nerve's short-circuiting pain, then repairing it would seem to be a logical goal.
Pharmaceutical science has medications to control the pain without any invasive or non-invasive treatment.
I was initially put on medicine but it mostly didn’t contain the pain. I had fleeting jabbing pain which would fade away at the most in a few hours. Pulses of electricity traveled through my cheeks. Doctors upped and upped my dosage but I was not satisfied.
I used to scream and awaken in pain when I turned onto the right side, the most painful side of my face.
I never knew how to cry because I was born without the vital emotion fear but when Trigeminal Neuralgia attacked me I learned to cry as the spontaneous facial pain that is predominantly constant and can be aching or burning in nature made it a tough battle for me every day and as I learned to shed tears of wicked pain hugging my mother at night when the soul screamed out with the agony and howling in pain. I hugged my mother and muttered and cried as the pain came loud and clear.
Because the length of time a blood vessel has been compressing the nerve may be the most significant concern. Blood vessels that beat on nerves year after year may cause a chronic injury that not only changes the nature of a person's pain but also makes it harder to treat. In that sense, largely, TN is a progressive disorder.
All my life I know one thing that is hope. I have undergone countless surgeries including cancer and a few life-threatening ones but I have never stopped as hope tells me better things are ahead...I can get through the toughest times. Hope tells me I'm stronger than the challenge I am facing for the past 12 years. Hope carries me to the right place and I found the right doctor in Mumbai HCG Khubchandani Cancer Center who said he could definitely treat me by cyberknife radiosurgery.
It's 5 months after the cyberknife and the doctor did the cyberknife fabulously but I have new problems even though I have achieved the "good numbness” in the nose, lips, and in the cheek partially as was told by the doctor is needed to get “good relief.”
A strange burning sensation on my tongue on that side. A weird pain creeps outside the trigeminal nerve's territory, maybe into the back of the head, the neck, a bump appearing in the anterior part of the tongue, hearing metallic noises, and unable to swallow pills or having coughing fits while eating? Extremely dry mouth. I have chosen mostly nutritious but liquid food or puree but what to do with my essential pills and the bump? I couldn't get the cyberknife of the left side neither meet any local doctors to solve the problems. I am immunocompromised with lung damage and the pandemic stopped my treatment. Nobody wears a mask in my neighborhood and one by one people keep getting the virus. I am willfully imprisoned in my rented flat since I returned after the cyberknife. Care for the vulnerable should be the thought behind wearing a mask.
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