TN News: How TN is diagnosed

Source: University of Virginia School of Medicine

According to a recent article in Therapeutics and Risk Management, the International Headache Society defines the diagnosis criteria for Trigeminal Neuralgia (TN) as greater than three sudden attacks of pain on one side of the face, meeting the following criteria:

• Pain occurs in region of the face with sensation supplied only by the trigeminal nerve without radiating outside of that area
• Pain that has 3/4 of the following: occurs repeatedly in attacks lasting from an instant less than a second up to 2 minutes, is extremely severe, feels like a shock of electricity or may also be described as shooting, stabbing or sharp; and occurs after ordinarily non-painful stimuli to face, like a breeze or brush of fabric, brushing teeth.

Your doctor may make a diagnosis based solely upon an interview with you where you describe your symptoms and medical history, including any dental surgeries, neuropathic pain conditions, or neurological diseases like Multiple Sclerosis. 

You may also be referred to a hospital to have imaging studies like an MRI or CT scan in hopes of locating the source of your pain. These imaging scans may also help your doctors rule out other conditions that can cause similar types of pain, including meningiomas, a type of tumor that grows from the lining of your brain.

Sources:
Advances in diagnosis and treatment of trigeminal neuralgia. Montano N, Conforti G, Di Bonaventura R, Meglio M, Fernandez E, Papacci F. Ther Clin Risk Manag. 2015 Feb 24; 11:289-99. doi: 10.2147/TCRM.S37592 eCollection 2015.

Trigeminal Neuralgia and Gamma Knife. (n.d.). Retrieved April 26, 2015, from http://www.medicine.virginia.edu/clinical/departments/neurosurgery/gammaknife/disorders/pain-page

TN News: Why and how TN hurts

Your trigeminal nerve is a cranial nerve located inside of your skull. It supplies sensation to your face as well as the ability to move your eyes. When you roll your eyes, you are using your trigeminal nerve!

When you have TN (trigeminal neuralgia), something as simple cotton swab being brushed lightly across your face can trigger a sensation of extreme pain. This pain travels from the surface of your skin to your trigeminal nerve, which carries the information (cotton swab has brushed face, here is what it feels like) to your brain. In people with TN, it seems that some kind of problem with the trigeminal nerve causes a sensation that might only cause us to sneeze or wrinkle our nose instead causes a sensation that puts us in excruciating pain.

Doctors disagree about what causes the trigeminal nerve to malfunction and cause these waves of pain. One theory is that the blood vessels near the root of the nerve are compromised in some way (by high blood pressure or build-up of gunk on the vessel walls) that reduces blood flow to the nerve, in essence starving the nerve and causing it to lose some of its protective coating (myellination). If you've ever accidentally been shocked by an electrical cord that had lost some of it's protective coating, the theory is similar. This theory is supported because there is a large amount of overlap between people with hypertension (high blood pressure) and people with TN. But why don't all people with high blood pressure get TN?

Doctors are still working on figuring out what causes TN so they can provide better treatment to patients with TN, perhaps even in time finding a cure.


Sources:
Sabalys G, Juodzbalys G, Wang HL. Aetiology and Pathogenesis of Trigeminal Neuralgia: a Comprehensive Review. URL: http://www.ejomr.org/JOMR/archives/2012/4/e2/v3n4e2ht.pdf doi: 10.5037/jomr.2012.3402

Trigeminal Neuralgia. Rudolph M. Krafft, MD, Northeastern Ohio Universities College of Medicine, Rootstown, Ohio. Am Fam Physician. 2008 May 1;77(9):1291-1296.

TN News: Who gets TN?

Estimates on the prevalence of Trigeminal neuralgia vary. According to studies cited by a recent paper published in 2013, TN is diagnosed for approximately 12.6 to 28.9 people per 100,000 every year. The disease is uncommon enough that it be very difficult for your doctor to diagnose.


TN is most common for women, and patients who have high blood pressure (hypertension), or multiple sclerosis, a chronic and debilitating disease that affect the myelin sheathes that protect your brain cells (neurons).

drawing by surrealdesirex, Trigeminal Neuralgia from deviantart.com

While TN does not cause death, it does cause excruciating pain, and was previously known by some as "suicide disease" because of the high potential for self-harm related to the experience of severe chronic pain.

So what are the options for patients with TN? There are options! Please come back next week to learn more about TN.

Sources:
 Increased risk of trigeminal neuralgia after hypertension: a population-based study. Neurology. 2011 Oct 25;77(17):1605-10. doi: 10.1212/WNL.0b013e3182343354. Epub 2011 Oct 12.

Neuropathic pain in the general population: a systematic review of epidemiological studies. 
Pain. 2014 Apr;155(4):654-62. doi: 10.1016/j.pain.2013.11.013. Epub 2013 Nov 26.

Spectrum of trigeminal neuralgia. J Ayub Med Coll Abbottabad. 2013 Jan-Jun;25(1-2):168-71.

TN News: What is Trigeminal Neuralgia?

According to Mayo Clinic:

Trigeminal neuralgia is a chronic pain condition that affects the trigeminal nerve, which carries sensation from your face to your brain. If you have trigeminal neuralgia, even mild stimulation of your face — such as from brushing your teeth or putting on makeup — may trigger a jolt of excruciating pain. (Mayo Clinic 2012, Trigeminal Neuralgia: Definition)

I became interested in TN (Trigeminal Neuralgia) when my parent was diagnosed with the condition following a severe sinus infection in 2013. The pain of this disease can be excruciating, and very literally, it was the very pain of being unable to brush her teeth that led my mother to seek medical attention.

Over the Spring 2015 quarter, we will together explore what TN (Trigeminal Neuralgia is, who it affects, how it affects patients, diagnosis, treatment, and other aspects related to this disease, known as one of the most painful disorders known to medical science today.

Sources:
Torpy JM. Rogers J. Golub RM. Trigeminal Neuralgia. JAMA. Retrieved 4-5-2015 from http://jama.jamanetwork.com/article.aspx?articleid=1667093

Mayo Clinic Staff. (August 10 2012). Trigeminal Neuralgia: Definition. Retrieved 4-5-2015 from http://www.mayoclinic.org/diseases-conditions/trigeminal-neuralgia/basics/definition/con-20043802

NIH National Institute of Neurologic Disorders and Stroke. (June 2013). Trigeminal Neuralgia Fact Sheet, NIH Publication No. 13-5116. Retrieved 4-5-2015 from http://www.ninds.nih.gov/disorders/trigeminal_neuralgia/detail_trigeminal_neuralgia.htm