Tic Doloureaux - Trigeminal Nerve Pain

If you suffer sudden sharp, severe pain lasting a few seconds to a minute in your lip, gum, chin, cheek on one side of your face, you probably have a condition called tic doloureux. One study shows that these attacks can be treated with a anticonvulsants such as gabapentin (1).

The pain of tic doloureux is caused by anything that presses on the trigeminal nerve that transmits feeling to one side of your face. The nerve starts in your brain and passes to the outside through a small hole in your skull, just in front of your ear. When still inside of your skull, the nerve passes next to an artery that pulsates with each beat of your heart. The artery can be so close to the nerve that it presses on it to cause severe pain on one side of the face. Most people can be treated successfully with the anticonvulsants, Tegretal or gabapentin, and by rubbing a special .025 percent capsaicin cream extract from hot peppers over the painful area many times a day. Those who continue to have pain when they are on these medications can benefit from special surgery in which a piece of muscle, fat or synthetic material is inserted between the nerve and artery.

Tic doloureux occurs almost exclusively in people over 60. When it starts at an earlier age, it can be the first sign of a disease that damages nerves, such as multiple sclerosis, lack of vitamin B12, diabetes, herpes, shingles or Lyme disease. People who have this condition can cause an attack by touching the face. Men can get attacks when they shave, while women can get them while applying facial powders or creams.

1) OA Khan. Gabapentin relieves trigeminal neuralgia in multiple sclerosis patients. Neurology 51: 2 (AUG 1998):611-614.

2)WP Cheshire. Trigeminal neuralgia: A guide to drug choice. CNS Drugs 7: 2 (FEB 1997):98-110. Carbamazepine is the drug of choice, and treatment requires careful dosage titration. Baclofen, phenytoin and sodium valproate are also effective. topical capsaicin, and tizanidine, lamotrigine, oxcarbazepine, pyridostigmine and enalapril have helped some patients. clonazepam is too sedating, pimozide induces extrapyramidal adverse effects, and tocainide and felbamate can cause aplastic anaemia. Phenobarbital (phenobarbitone), opioids, mexiletine, tricyclic antidepressants, corticosteroids, nonsteroidal anti-inflammatory drugs and sympatholytics are ineffective.

Checked 2/1/13

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