Jeffrey A. Brown, M.D., FACS
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Trigeminal Neuralgia

Herod's Pain Nicholas Andre coined the term tic douloureux to describe this disease, one that had been called "spasme cynique" or cynical spasm--the expression of a dog about to bite. It is a terrible pain. Patients have been known to be driven to suicide in frustration. Too often it is misdiagnosed as a tooth pain; too often the burden of diagnosis falls on the dentist who does not understand it, or the oral surgeon who believes that the removal of an offending tooth will eliminate the pain, too.

The average time until accurate diagnosis for this disease is over three years. What characterizes it?

Trigeminal neuralgia is a progressive disease of the fifth cranial nerve that usually develops in women who are on the average 65 years old. It is diagnosed by the description of the pain it generates: an intermittent, electric jolt on one side of the face that is often triggered by lightly touching the face, talking, chewing or facing a cool breeze. It is a progressive disorder. At first there may only be a vague discomfort, an intermittent "tingling" in thecheek or jaw. Later the tingling will turn to be a jolt. The jolt is brief, but there may be an underlying aching pain between shocks and, after time perhaps years later a constant burning pain where there used to be only shocks.

What causes it?

We hypothesize that trigeminal neuralgia is a consequence of a "short circuit" in the nerve, one that is caused by an small artery rubbing off the insulation by repeatedly pounding against it in a sensitive zone. For the first few millimeters after the nerve exits the brainstem it is covered by weaker insulation designed to protect the nerve inside the brain and not outside it. To have a short circuit the "switch" must be turned on. This occurs when there is sensory stimulation. Touching the face, chewing or talking are adequate stimuli. This sends sufficient electrical input through the nerve that the short circuit and shock are triggered.


Trigeminal neuralgia is treatable, though not curable. Once it develops, it may relapse, but it will never spontaneously resolve.

Percutaneous Balloon Compression is an outpatient treatment for Trigeminal Neuralgia.

Observations-Pratiques sur Les Maladies de L'Urethre

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