Tic douloureux

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Trigeminal neuralgia, also known as tic douloureux, is a chronic pain condition that causes burning or shock-like pain in the face. Nicolaus Andre, a French physician, coined the term “tic douloureux” in 1756 in reference to the facial spasms that can occur during severe pain attacks.

The pain that occurs in short, unpredictable episodes rarely lasts more than a few seconds or a minute or two in a trigeminal neuralgia attack. The pain can feel like an electric shock or can be described as a sharp shooting pain.

Generally, trigeminal neuralgia affects just one side of the face. The pain is felt on the lower part of the face. Trigeminal neuralgia can progress to cause longer, more frequent attacks of searing pain.

The pain can sometimes affect both sides of the face, though not always at the same time.

The intensity of pain can be physically and psychologically incapacitating. People with tic douloureux may have regular attacks for days, weeks or months at a time. In severe cases attacks may happen hundreds of times a day.

Even though it can be debilitating, this disorder does not pose a life-threatening threat. A spontaneous remission is possible, although most people experience episodes over a long period of time.

The anatomy of the trigeminal nerve

This nerve supplies the face with sensory information and provides motor and sensory input to the masticatory muscles. It is a fifth cranial nerve (CN V).

Three trigeminal nerves split off from the trigeminal nerve (trigeminal = threefold):

  1. Ophthalmic (V1): Supplies the eye, upper eyelid, and the forehead
  2. Maxillary (V2): Supplies lower eyelid, cheek, nostril, upper lip, and upper gum
  3. Mandibular (V3): Supplies the lower lip, lower gum, jaw and the muscles of mastication

The mandibular division of the trigeminal nerve provides somatic motor innervation for the chewing muscles. The trigeminal nerve is a mixed nerve and it supplies the general somatic sensory function for touch, temperature, and pain in the face.

This figure shows the fifth cranial nerve, the trigeminal nerve.

Tic douloureux causes

Trigeminal neuralgia, also known as tic douloureux, occurs when the trigeminal nerve’s function is disrupted. Most cases result from compression of the trigeminal nerve root near its entry point into the pons.The problem is usually caused by a contact between a blood vessel – in this case, an artery or a vein – and the trigeminal nerve at the base of your brain. This pressure puts pressure on the nerve, causing it to malfunction.

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