Atypical trigeminal neuralgia

Atypical Trigaminal Neuralgia (ATN) is a rare form of Trigeminal Neuralgia, a disease of the fifth cranial nerve. This may also be the most misdiagnosed form of neuralgia. The symptoms can be mistaken for migraines, dental problems such as TMJ, musculoskeletal issues, and hypochondriasis. ATN can have a wide range of symptoms and the pain can fluctuate in intensity from mild aching to a crushing or burning sensation, and also to the extreme pain experienced with the more common trigeminal neuralgia.

Symptoms

ATN pain can be described as heavy, aching, and burning. Suffers have a constant migraine-like headache and experience pain in all three trigeminal nerve branches, which include the following:

• aching teeth

• ear aches

• feeling of fullness in sinuses

• cheek pain

• pain in forehead and temples

• extreme jaw pain

• pain around eyes

• occasional icy electric-like shocks shooting from the temples to the teeth

Pain tends to worsen with talking, facial expressions (such as smiling), eating, and certain sensations such as breathing in extremely cold air. The pain from ATN is usually less than that of typical trigeminal neuralgia, but is nearly continuous and periods of remission are rare. Unlike typical neuralgia, this form can also cause pain in the back of the scalp and neck.

Causes

Vascular compression of the trigeminal nerve is a common cause. This can only be diagnosed using magnetic resonance angiography. Infections of the teeth or sinuses, physical trauma, or past viral infections could also cause ATN. An interesting aspect is that this form affects men and women equally, unlike the trigeminal neuralgia, which is much more common in women than men.

Treatment

Treatment options include medicines, surgery, and complementary approaches.

High doses of anticonvulsant medicines—used to block nerve firing— and tricyclic antidepressants are generally effective in treating TN. If medication fails to relieve pain or produces intolerable side effects, surgical treatment may be recommended.

Some degree of facial numbness is expected after most of these procedures, and TN might return despite the procedure’s initial success. Depending on the procedure, other surgical risks include hearing loss, balance problems, infection, and stroke. These surgeries include rhizotomies (which select nerve fibers are destroyed to block pain) and Microvascular decompression (the surgeon moves away the vessels that are compressing the nerve and places a soft cushion between the nerve and the vessels).

Some patients choose to manage TN using complementary techniques, usually in combination with drug treatment. These therapies offer varying degrees of success. Options include acupuncture, biofeedback, vitamin therapy, nutritional therapy, hot-cold therapy, and electrical stimulation of the nerves.

Risks

Neuralgia usually goes undiagnosed or misdiagnosed for extended periods, leading to a great deal of pain and frustration on the part of the patient. This disease has earned the nickname "the suicide disease," due to the unfortunate and drastic steps some have taken when they have been unable to find relief. Patients exhibiting symptoms need to be persistent, and willing to try different doctors to find the help they need. Sleep deprivation and malnutrition have also been reported as byproducts of the pain. It is possible that there are other triggers or aggravating factors that patients need to learn to recognize to help manage their health. Bright lights, sounds, stress, and poor diet are examples of additional stimuli that can contribute to the condition. The pain can cause nausea, so beyond the obvious need to treat the pain, it is important to be sure to try to get adequate rest and nutrition.

• 
  Trigeminal Nerve

External links

• [1]