When to Seek Medical Care
Call your doctor when the prescribed medications are not controlling the pain, or if you develop new symptoms. Because tic douloureux is a pain-only syndrome, the development of new symptoms may warrant additional evaluation.
Go to a hospital's emergency department if you experience symptoms such as fever, redness of your face, or dizziness. These symptoms may not be related to your condition and may signify another illness. If your prescribed medication is not relieving the pain and your doctor is not available for advice, go to the hospital.
Exams and Tests
There is no single medical test to diagnose tic douloureux. The diagnosis is made based on the description of the pain, physical examination, and exclusion of other causes of facial pain.
- The pain of tic douloureux is unique. A history of bursts of shooting pain in one side of the face along with a trigger zone will give the doctor good clues to the cause of your pain.
- The physical examination is normal in tic douloureux. If numbness, decreased hearing, dizziness, visual changes, or dysfunction of the muscles of the face is found, then other disorders may be considered. Additionally, other causes of facial pain such as a sinus infection, dental infection, or a jaw disorder, such as TMJ, can often be found by physical examination.
- Special x-ray images, such as a CT scan or MRI of the head, can look for other causes of facial pain. They can also help delineate blood vessels or tumors that might be pressing on the nerve and irritating it.
Tic Douloureux Treatment
Self-Care at Home
There are no effective home treatment remedies for tic douloureux. Treatment should be guided by a physician. The role of the doctor is to ensure the diagnosis, begin appropriate therapy, and coordinate any potential need for consultants. In most cases, effective treatment will require only medications. Uncommonly, surgery will be recommended.
The primary treatment of tic douloureux is medication to control the pain. Surgery may be necessary when drug therapy is not effective or side effects from the medications are not tolerable.
A number of medications are effective in helping control the pain of tic douloureux. The most commonly prescribed medications are anticonvulsants (seizure medications). Anticonvulsants help to stop the irritated trigeminal nerve from firing pain impulses.
- The most frequently prescribed anticonvulsant medication for tic douloureux is carbamazepine (Tegretol). Other anticonvulsants used include phenytoin (Dilantin) and gabapentin (Neurontin). These medications are generally started at a low dose and then increased until pain is controlled or side effects occur. Common side effects include drowsiness, dizziness, double vision, and nausea. Rarely, serious liver or bone marrow problems can occur.
- Baclofen (Lioresal), a muscle relaxant, is useful for some people who either do not respond to anticonvulsants or who suffer serious side effects.
- Opioid pain medications can be useful during episodes of severe pain.
- Medication is 80% effective. For the other 20%, drug therapy either fails to provide adequate pain control or adverse side effects are intolerable. Unfortunately, up to 50% of people who initially respond to anticonvulsants eventually develop resistance to the medications.
When pain cannot be controlled with medication, surgical options should be discussed with a neurosurgeon. Surgery could range from simple injections of anesthetic into the trigeminal nerve to complex procedures that must be performed in the operating room. In general, the more complex procedures provide longer-lasting pain relief but with greater potential for more serious complications.