Do you feel a pain like an electric shock in your face? This is about Tic Douloureux (Trigeminal Neuralgia)

Have you ever felt an unbearable pain on one side of your face, like an electric shock, when you were brushing your teeth, shaving, or just a gust of wind? This intense pain that comes and goes in a matter of seconds, but at that moment, makes you feel completely out of sorts, must have left you feeling very scared and anxious. Today we are going to talk about this condition that affects many people, but they don't know much about it.

What is this Tic Douloureux?

Simply put, Tic Douloureux is a condition medically known as `trigeminal neuralgia` . This is a condition in which a person experiences a sharp, stabbing or electric shock-like pain on one side of the face due to a problem with the trigeminal nerve, the main nerve that supplies sensation to our face. This pain is so severe that sometimes the face twitches involuntarily when the pain occurs. That is the meaning of the English word "tic".

This pain usually lasts from a few seconds to a few minutes. But these attacks can occur several times a day. The strange thing is that when there is no pain, there is no tingling or other problem in the face.

Many people experience this pain on only one side of their face, in the jaw, cheek, or lip. The pain is so severe that some people are afraid to talk, eat, or even drink water during attacks.

What is the cause of this severe pain?

Although it is impossible to say exactly what the reason for this is, there are several opinions on this.

The most widely accepted theory is that a blood vessel (usually an artery) in the brain is compressed on the trigeminal nerve, causing damage to the nerve. Think of it like a water pipe being crushed when a weight is placed on it. Over time, this compression damages the protective covering around the nerve, called the myelin sheath . It's like the insulation on an electrical wire wearing away. The nerve then becomes hypersensitive and starts sending pain signals to the brain for no apparent reason.

In addition, brain tumors, certain abnormalities in the bones of the skull, head injuries from accidents, infections, and Multiple Sclerosis ( MS) can cause seizures.)` can also cause pain by damaging the trigeminal nerve.

What exactly are the symptoms?

The main and only symptom of this disease is pain. But that pain has several special characteristics. Let's see what they are.

Most importantly, this condition does not affect taste, hearing, or facial muscle function. This means that it is a condition limited to pain only .

When is it best to seek medical advice?

• If the pain is not controlled by the medication your doctor has prescribed, be sure to see your doctor again.
• If you develop any new symptoms in addition to the pain (e.g., facial numbness, hearing loss, dizziness , vision changes), you should also tell your doctor. Because tic douloureux is a condition that only causes pain, new symptoms could be a sign of another medical condition.

When do you want to go to ETU?

If you experience symptoms such as fever, flushing , or severe dizziness along with the pain, it could be a sign of a more serious condition. In such cases, it is best to go to a hospital's emergency room (ETU) as soon as possible. Also, if the pain is unbearable and you cannot reach your doctor, it is wise to go to the ETU.

How do you find this, Doctor?

There is no single specific test to diagnose this condition. Your doctor will make the diagnosis based primarily on your description of your symptoms, a physical exam , and ruling out other conditions that could be causing your facial pain .

1. Description of symptoms: The electric shock-like pain you describe, the way it comes, and the triggers will give the doctor a good clue about this disease.

2. Physical examination: Usually , no abnormalities are found when examining a patient with tic douloureux. However, if there is something like facial numbness or hearing loss, the doctor will suspect other diseases. Also, things like sinus infection, dental infection, and temporomandibular joint (TMJ) problems can be found on a physical examination.

3. Scans: A CT or MRI scan of the brain can check for a blood vessel or tumor pressing on a nerve. These tests can also help rule out other possible causes of facial pain.

What are the treatments for this?

There are no home remedies for this pain. Treatment should definitely be sought under the guidance of a doctor. Often, the pain can be successfully controlled with medication. Rarely, surgery is required.

Medications

Anticonvulsants are the main drugs used to control this pain. These drugs work by stopping the damaged trigeminal nerve from sending unnecessary pain signals.

• Main medications: The most commonly used drug is `Carbamazepine (Tegretol). In addition, drugs such as `Oxcarbazepine (Trileptal)`, `Gabapentin (Neurontin)`, and `Lamotrigine (Lamictal)` have also been used successfully.
• Side effects: These medications are started at a low dose. The dose is gradually increased until the pain is controlled. Side effects such as drowsiness, dizziness, double vision, and nausea may occur.
• Other medications: For those who do not respond to the above medications or who have severe side effects, the muscle relaxant Baclofen (Lioresal) and, in some cases, Pimozide (Orap) may be helpful. Botox injections have also been shown to provide significant pain relief.

Surgery

If medication does not control the pain or the side effects of medication are intolerable, surgery may be considered. This may involve seeing a neurosurgeon. There are a variety of options, from simple procedures such as injecting a local anesthetic into the nerve to complex surgeries that open the brain. Although complex surgeries usually provide long-term relief, they are associated with higher risks.

Can this situation be prevented?

Unfortunately, there is no way to prevent tic douloureux from occurring.