Psychiatry

Tic douloureux

Tic douloureux or trigeminal neuralgia is a severe, stabbing pain to one side of the face. Trigeminal nerve – a V pair of cranial nerves. A nerve forms on a front surface the pyramids of temporal bone a bulge of sensible counterfoil of the trigeminal nerve – trigeminal node. Three basic branches of the trigeminal nerve are divided on more shallow, innervating the face, ears, gums, teeth and greater part of tongue. Most often there is neuralgia one of the three branches of the trigeminal nerve. More frequent elderly people suffer from tic douloureux.

Tic douloureux is characterized by attacks of severe pain, usually localized to one side of the face. The attack lasts a few seconds. There may be one-sided or bilateral tic – reflex twitch of muscles of person. Usually before the beginning of pain attack the staggered area of skin blushes; nasal, tear and salivary glands are selected by a more secret. During some time after an attack the staggered area of skin as if becomes numb, does not respond on pain irritants.

Symptoms

  • Sudden, the most severe pain.
  • Burning, redness of the affected side of the face.
  • Muscle cramps, painful tic.

Causes

Trigeminal neuralgia is divided into symptomatic, trigeminal and essential. At a symptomatic neuralgia the cause of pains is some other concomitant illness, such as a tumor of the cerebellum, metastasis, meningitis, etc. The cause of trigeminal neuralgia – illnesses of eyes, inflammation of nose, ears, frontal or jaw sinuses. The cause of essential tic douloureux until now is not clear. It is assumed that it is based on the defeat of the nerve fibers. Other possible causes of neuralgia – heavy metal poisoning, diabetes. Neuralgia may also occur due to compression of the trigeminal nerve arteries, which are affected by atherosclerosis.

Treatment

At first, tic douloureux is treated by medications (antidepressants, psychotropic drugs etc.). Anticonvulsant medications render an anaesthetic action, antidepressants are appointed at vibrations moods and persistent pains. At unsuccessfulness of medicinal treatment, nerves are exposed to thermal influence – cautery and destruction (to the so-called thermocoagulation). At first, it is necessary to affect nerves, passing in accessible places. However, if, in spite of the conducted treatment, a neuralgia does not disappear, there is a necessity for the brain surgery and displacement of squeezing artery.

As a rule, patients, sufferings from a tic douloureux, know that causes an attack. Therefore they must consciously avoid irritants.

Great pains compel a man to appeal to the doctor. The family doctor refers the patient to a specialist.

First of all, it is needed to find out whether there is a symptomatic neuralgia or not. To do this, computed tomography is performed, sometimes – the study of cerebrospinal fluid.

A patient must pass an inspection at otolaryngologist, stomatology and oculist. At a symptomatic neuralgia it is needed to treat basic illness. At an essential tic douloureux the afore-mentioned methods of treatment are used.

Course of the disease

At first, the pain is rarely repeated. But over time, attacks become more frequent, while, finally, fail to appear once or twice in a day. As a rule, a patient does not feel pain at night.

At essential neuralgia at first only one branch of the nerve is struck. But the longer the disease, the higher the probability of destruction and other branches of the trigeminal nerve. Often the cause of pain attack is external stimuli such as touch, cold weather, and others.

Quite often at neuralgic pains doctors by mistake diagnose illnesses of teeth or jaw, so delete teeth, wash or operate jaw bosoms, but pains do not pass. Tic douloureux is characterized by trigeminal pain, and at illnesses of teeth or jaw such pains does not happen.