2-Minute Neuroscience: Trigeminal Neuralgia

Trigeminal neuralgia, also known as tic douloureux, is an extremely painful disorder of cranial nerve V, the trigeminal nerve. In this video, I discuss the symptoms, pathophysiology, and treatment of trigeminal neuralgia.

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TRANSCRIPT

Trigeminal neuralgia, also known as tic douloureux, is a disorder of cranial nerve V, the trigeminal nerve. The trigeminal nerve is the main sensory nerve for the face; it also controls motor functions of the jaw like biting and chewing. Trigeminal neuralgia is a pain disorder that causes sudden intense pain, typically on one side of the face. The pain usually lasts for only a few seconds, although it may continue for up to a couple minutes at a time. The pain is recurrent, and can arise spontaneously or be triggered by various stimuli such as light touch, talking, or chewing. Some patients also experience a continuous pain that remains present between more intense pain episodes. Trigeminal neuralgia is an extremely painful condition, and having the condition can substantially impact one’s mental health, increasing the risk of depression and suicide.

The pathophysiology underlying trigeminal neuralgia is not completely understood, and the cause can be different in different cases. Many cases involve hyperexcitability of the trigeminal nerve, which leads to increased activation of the nerve and pain as a result. Often, compression of the trigeminal nerve, usually by a blood vessel, plays an important role. This compression can lead to a disruption of myelination of the trigeminal nerve, which can make the nerve hyperexcitable. Some patients do not show evidence of nerve compression, however, and thus other factors, such as other anatomical changes or a genetic predisposition to nerve excitability may play a role.

A number of different medications can be used to treat trigeminal neuralgia, with the first-line treatment typically being anticonvulsant medications due to their ability to reduce neuronal excitability (and thus decrease the hyperexcitability of the trigeminal nerve). If medication is not effective in controlling the pain of trigeminal neuralgia, surgery may be necessary. There are several different surgical procedures that can be used, with the choice of procedure being based on the identified cause of the condition.

REFERENCES

Ashina S, Robertson CE, Srikiatkhachorn A, Di Stefano G, Donnet A, Hodaie M, Obermann M, Romero-Reyes M, Park YS, Cruccu G, Bendtsen L. Trigeminal neuralgia. Nat Rev Dis Primers. 2024 May 30;10(1):39. doi: 10.1038/s41572-024-00523-z. PMID: 38816415.

Bendtsen L, Zakrzewska JM, Heinskou TB, Hodaie M, Leal PRL, Nurmikko T, Obermann M, Cruccu G, Maarbjerg S. Advances in diagnosis, classification, pathophysiology, and management of trigeminal neuralgia. Lancet Neurol. 2020 Sep;19(9):784-796. doi: 10.1016/S1474-4422(20)30233-7. PMID: 32822636.

Cruccu G, Di Stefano G, Truini A. Trigeminal Neuralgia. N Engl J Med. 2020 Aug 20;383(8):754-762. doi: 10.1056/NEJMra1914484. PMID: 32813951.


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