Trigeminal neuralgia (TN) is one of the most painful disorders known and may be second only to cluster headaches in degree of pain it produces. Like cluster headaches, trigeminal neuralgia is also known by many as the suicide disease. When describing someone suffering a TN attack, the chairman of Oregon Health & Science University School of Medicine’s department of neurological surgery, Kim Burchiel, M.D., said: “They are begging to be killed.” The trigeminal nerve is responsible for the transmission of all sensory information from the face and head. This includes temperature, pain, and tactile/pressure sensation. Most of us are familiar with the luxury of a functional trigeminal nerve, being pinched on the cheek hurts but the pain is bearable and fades quickly, soft touches are sensuous, and wind on one’s face can be quite the invigorating experience. If this nerve bundle becomes irritated or damaged it can begin to malfunction in the most extreme way. The invigorating wind and sensuous touch can become the trigger for severe sensations of searing, slicing, stabbing, lacerating pain in the mouth, teeth, eye, cheek and ear lasting from a few minutes to several hours. Usually only one side of the face is afflicted though rarely TN can occur bilaterally (1).
There are several ways in which the trigeminal nerve can become irritated and/or damaged through direct assault or more passive demyelination. The most common cause is believed to be vascular compression of the nerve bundle close to where it enervates with the brain stem. This pressure irritates the nerve interfering with its ability to function properly. Eventually the irritation results in demyelination and severe neural dysfunction. The dysfunctional nerve now fires erratically, becomes hypersensitive, and may no long be able to terminate a sensation once the corresponding stimulus has been removed. As a result, someone suffering from this condition will experience paroxysmal allodynia, the sudden onset of extreme pain initiated by non-painful stimuli such as a feather brushing the cheek. Other suspected causes include pressure from tumor, cystic spider bite in the right location, damage from multiple sclerosis, car accident, facial surgery or even body piercing (1).