Trigeminal Neuralgia (tic douloureux)

Explanation of Disease

condition of the fifth cranial nerve that is

characterized by paroxysms of pain in the area
innervated by any of the three branches ,but most
commonly the third and the second branches of
the trigeminal artery.the pain ends as abruptly as it
starts and is described as a unilateral shooting or
stabbing sensation. Associated involuntary
contraction of the facial muscles can cause sudden
closing of the eyes or twitching of the
mouth,hence the name tic douloureux (painful
twitch).

Normal Function of Organ

Trigeminal neuralgia: carries sensation from your

face to your brain

Pathophysiology

Vascular compression and pressure.

Demylination of the trigeminal root.
Paroxysms can occurwith stimulation of the
terminals of the affected nerve branches such as
washing the face,shaving,brushing the teeth,eating
and drinking.A draft of cold air or direct pressure
against the nerve trunk may also cause
pain.Certain areas are called trigger points
because the slightest touch shows paroxysm or
episode.To avoid stimulating these areas patients
with trigeminal neuralgia, try not to touch or wash
the faces,shave,chew or do anything that may
cause an attack.

Cause/ risk factors

Health Promotion and Disease prevention
Clinical Manifestations

Intermittent episodes of intense pain with sudden

onset,The pain is rarely relieved by analgesics
pain generally starts peripherally and advances
centrally
some patient have a trigger zone and others are
triggered by light touch
Tactile stimulation such as touch and facial
hygiene and even talking will trigger an attack

Diagnostic tests or Labs

History collection and physical examination

Angiography ,CT Scan and MRI will identify a
causative lesion.
The actual diagnosis is made by history
collection

Nursing Diagnosis

Acute pain
activity intolerance
ADL deficit, self care
hopelessness

Goals of Treatment

Reduce pain

Medical/ surgical Treatment

Surgical treatment; microvascualr decompression

(remove blood vessel from post. Trig. Root) or
rhizotomy (surgical severing of nerve root)

Nursing Interventions

Preventing pain-Recognize the factors that

alleviate the pain such as food that is too hot or
too cold and jarring of the patient s bed on the
chair. Even washing the face, combing the hair
and brushing the teeth can produce acute pain. the
nurse should assist the patient by providing
education regarding how to decrease the pain.
Provide cotton pads and room temperature water
to wash the face.
Instruct the patient to use mouth wash to cleanse
the mouth after taking food if tooth brush causes
pain., instruct the patient to do personal hygiene
when there is no pain.
The patient is instructed to eat the food at room
temperature and to chew the food in the
unaffected site, and to ingest soft foods.
Provide psychological support

Medication Treatment

Antiseizure medications such as Carbamazepine

(Tegretol),relieves pain by reducing the
transmission of impulses at certain nerve
terminals.
NC: taken along with meals; Serum levels should
be monitored continuously
Side effects: n/v, dizziness,drowsiness and
aplastic anemia.
The patient should be monitored continuously for
bone marrow depression during long term therapy.
Gabapentin(Neurontin)and Baclofen(Lioresal)is
used for pain control (antispasmodics)
Phenytoin can also be used.

Complications
Dietary Therapy

Chew on unaffected side

Patient Education

Avoid triggers for pain: firm toothbrush, very hot

or cold foods or liquids, mechanical pressure on
cheeks