Tic douloureux or trigeminal neuralgia is a severe, stabbing pain to one side of the face. It stems from one or more branches of the nerve that supplies sensation to the face, the trigeminal nerve. It is considered one of the most painful conditions to affect people.
The pain usually lasts from a few seconds to a few minutes. It may be so intense that you wince involuntarily, hence the term tic. There is usually no pain or numbness between attacks and no dysfunction of the muscles of the face.
Most people feel the pain in their jaw, cheek, or lip on one side of the face only. Pain is usually triggered by a light touch of the face or mouth on the same side as the pain. The pain is so severe that people can become afraid to talk, eat, or move during periods of attacks.
Although a flurry of attacks can last for weeks or months, there are usually periods of months or even years that are symptom-free. The pain of tic douloureux is usually controlled with medications or surgery.
Tic douloureux is generally a disease of middle age or later life. Women are affected more often than men. People with multiple sclerosis are affected much more frequently than the general population.
Tic Douloureux Causes
The cause of tic douloureux is unknown. There are a number of theories as to why the trigeminal nerve is affected.
The most commonly accepted theory is compression of the trigeminal nerve, usually by a blood vessel, causing it to become irritated. This irritation causes the outer covering of the nerve (the myelin sheath) to erode over time. The irritated nerve then becomes more excitable and erratically fires pain impulses.
Tumors and bony abnormalities of the skull may also press on and irritate the trigeminal nerve.
Trauma, infections, and multiple sclerosis can also cause damage to the trigeminal nerve.
Tic Douloureux Symptoms
The main symptom of tic douloureux is a sudden, severe, stabbing, sharp, shooting, electric-shock-like pain on one side of the face. Because the second and third divisions of the trigeminal nerve are the most commonly affected, the pain is usually felt in the lower half of the face.
The pain comes in intermittent episodes that last from a few seconds to a few minutes. There may be many episodes of pain per day. There is no pain between episodes.
The flurry of pain episodes may last from a few weeks to a few months, followed by pain-free periods of months to even years. Generally, the episodes become more frequent and more resistant to treatment with medications over time.
The attacks of pain are often initiated by physical stimulation of a trigger point on the same side of the face as the pain. Trigger points can be anywhere on the face or in the mouth or nose. They are generally not in the same place as the pain. Stimuli that can initiate the pain include talking, eating, brushing the teeth, or even cool air on the face. There is no loss of taste, hearing, or sensation in someone suffering from tic douloureux.