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Trigeminal neuralgia

Trigeminal neuralgia is also known as tic douloureux. It affects the trigeminal (fifth cranial) nerve, which supplies sensation to one side of the face.

This condition tends to come on in an adults later years, and occurs in episodes which become more frequent and more severe with time. There are quite often intervals with no pain.

Patients typically describe severe, sharp pain that can be like an electric shock and most often affects the lower or upper jaw and occasionally the forehead. It can be precipitated by touching these areas, chewing or talking.

In most cases, the cause is a loop of artery lying in contact with the trigeminal nerve, just as it approaches the brain stem. Less often it is a small vein.

In a few percent of cases the cause is a tumour (usually benign) which is why all patients should have an MRI scan. If the tumour is found, surgery is often advised.

Medications usually help in the early stage. The most effective medication is Carbamazepine (Tegretol). When medication is inadequate, Dr Steel can perform facial injections or micro vascular decompression. This involves a small craniotomy behind the ear.

Using a microscope the offending blood vessel is separated from the trigeminal nerve and kept permanently away by a small pad of cotton wool. This procedure is 90% effective in alleviating the pain.