My patient, who has severe intermittent facial pain, has been diagnosed with trigeminal neuralgia (TN). What do I need to know about TN?-R.M., OKLA.

Marina E. Bitanga, BSN, RN, CCRN, and Madeleine Austria, BSN, RN, CCRN, respond: TN, a painful, chronic, and debilitating disorder, involves the trigeminal nerve, which is the fifth cranial nerve (CN V).1 About 150,000 people are diagnosed with TN every year. Although the disorder can occur at any age, people over age 50 are more commonly affected. More women are affected by TN than men. Family history may also be a risk factor.2,3

TN is divided into TN type 1 (TN1) and TN type 2 (TN2). TN1, which is also called classic TN, is caused by neurovascular compression or it may be idiopathic. It's characterized by intense attacks and stabbing pain. TN2 is atypical TN, which is caused by compression of the trigeminal nerve. It may be idiopathic or due to underlying causes such as a tumor or multiple sclerosis.4

TN causes recurrent intense, sharp, superficial, or stabbing facial pain that's usually unilateral within the distribution of one or more branches of the trigeminal nerve.5,6 The pain attack is typically accompanied by an uncontrollable facial twitching and muscle spasm (tic douloureux).7 Pain seldom lasts for more than a few seconds or a minute or two per episode, but the episodes can recur for days, weeks, or months at a time and then disappear for months or years.8 The attacks often worsen over time with fewer and shorter pain-free episodes before recurrence.8 Although TN isn't life-threatening, it can cause pain severe enough to cause intense physical and emotional distress.6

The pain may be triggered by mild tactile stimuli including brushing teeth, washing the face, shaving, drinking hot or cold drinks, chewing, talking, blowing the nose, or even receiving a light touch on the face.9 Episodes can also occur spontaneously without any apparent trigger.4

The diagnosis of TN is based on the characteristic clinical features.9 Neuroimaging may be used to help distinguish classic TN from atypical TN.

Pharmacologic therapy is used for initial treatment of most patients with TN. Carbamazepine, an antiepileptic drug, is frequently used to control pain. Surgery, such as microvascular decompression, is reserved for patients who are refractory to medical therapy.9

Advise patients to adhere to the medication regimen, to avoid activities that may trigger TN, and to report any altered facial sensations.1

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