Trigeminal neuralgia has been considered one of mankind's most painful disorders and has even been known to lead to suicide. This disorder of the fifth cranial nerve is characterised by extreme pain of the face without an obvious underlying cause. Although the upper teeth and midface regions are the most commonly affected areas, trigeminal neuralgia can trigger pain in the eyes, jaw, teeth, neck, nose and ears.
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Trigeminal neuralgia was first reported in 1672, but this disorder has no doubt plagued mankind for millennia. The disorder was formerly referred to as tic douloureux, an unbearably painful twitch.
Symptoms of trigeminal neuralgia include intense and recurring pain attacks. The pain typically radiates from a single point on the face and may last from a few seconds to several minutes. In atypical trigeminal neuralgia the pain is constant, only fluctuating in intensity. Points of origin are typically the mid-portion of the face, primarily the lips, upper teeth and nose, but may also include the jaw, cheeks, ears.
Symptoms of trigeminal neuralgia may be triggered by seemingly innocuous occurrences such a kiss or a breeze blowing across the skin. No one really knows what causes trigeminal neuralgia, but several theories have been put forth involving the interaction of redundant blood vessels with the nervous system.
While any type of unexplained facial pain is frequently, and inadequately, diagnosed as trigeminal neuralgia, unexplained ear pain may also result from a number of other disorders. Glossopharyngeal neuralgia exhibits symptoms that are quite similar to trigeminal neuralgia but originates from the glossopharyngeal nerve--the primary nerve cluster that serves the ears, throat, tongue and jaw. Occipital neuralgia is characterised by pain radiating from the back of the skull through the ear to the top of the head. It typically presents only on one side of the head.
A correct diagnosis of the underlying cause of ear pain is important because the originating systems respond to different treatments. Glossopharyngeal neuralgia may response to anticonvulsant medication or microvascular decompression, while occipital neuralgia responds better to certain antidepressants or local anesthetics. Trigeminal neuralgia is typically treated with carbamazepine which has proven effective in 70 to 90 per cent of patients. When relief cannot be obtained through medication, surgery may be required.
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