Editing Trigeminal neuralgia (section)

==Signs and symptoms==
[[File:Trigeminal Neuralgia.png|thumb|Trigeminal neuralgia]]
This disorder is characterized by episodes of severe facial pain along the trigeminal nerve divisions. The trigeminal nerve is a paired [[cranial nerve]] that has three major branches: the [[ophthalmic nerve]] (V<sub>1</sub>), the [[maxillary nerve]] (V<sub>2</sub>), and the [[mandibular nerve]] (V<sub>3</sub>). One, two, or all three branches of the nerve may be affected. Trigeminal neuralgia most commonly involves the middle branch (the maxillary nerve or V<sub>2</sub>) and lower branch (mandibular nerve or V<sub>3</sub>) of the trigeminal nerve.<ref>{{cite web |title=Trigeminal Neuralgia and Hemifacial Spasm |url=http://com-neurosurgery-a2.sites.medinfo.ufl.edu/files/2012/11/trigeminal_neuralgia_brochure_for_web.pdf |publisher=[[UF Health Shands Hospital]]|date=November 2012|access-date=5 April 2021}}</ref>

An individual attack usually lasts from a few seconds to several minutes or hours, but these can repeat for hours with very short intervals between attacks. In other instances, only 4–10 attacks are experienced daily. The episodes of intense pain may occur [[paroxysm]]ally. To describe the pain sensation, people often describe a trigger area on the face so sensitive that touching or even air currents can trigger an episode; however, in many people, the pain is generated spontaneously without any apparent stimulation.

It affects lifestyle as it can be triggered by common activities such as eating, talking, shaving and brushing teeth. The wind, chewing, and talking can aggravate the condition in many patients. The attacks are said, by those affected, to feel like stabbing [[electric shock]]s, burning, sharp, pressing, crushing, exploding or shooting pain that becomes intractable.<ref name=":0" />

The pain also tends to occur in cycles with remissions lasting months or even years. Pain attacks are known to worsen in frequency or severity over time, in some people. Pain may migrate to other branches over time but in some people remains very stable.<ref name="Bayer1979">{{cite journal | vauthors = Bayer DB, Stenger TG | title = Trigeminal neuralgia: an overview | journal = Oral Surgery, Oral Medicine, and Oral Pathology | volume = 48 | issue = 5 | pages = 393–399 | date = November 1979 | pmid = 226915 | doi = 10.1016/0030-4220(79)90064-1 }}</ref>

Bilateral (occurring on both sides) trigeminal neuralgia is very rare except for trigeminal neuralgia caused by [[multiple sclerosis]] (MS). This normally indicates problems with both trigeminal nerves, since one nerve serves the left side of the face and the other serves the right side. Occasional reports of bilateral trigeminal neuralgia reflect successive episodes of unilateral (only one side) pain switching the side of the face rather than pain occurring simultaneously on both sides.<ref>{{cite journal | vauthors = Cruccu G, Finnerup NB, Jensen TS, Scholz J, Sindou M, Svensson P, Treede RD, Zakrzewska JM, Nurmikko T | title = Trigeminal neuralgia: New classification and diagnostic grading for practice and research | journal = Neurology | volume = 87 | issue = 2 | pages = 220–228 | date = July 2016 | pmid = 27306631 | pmc = 4940067 | doi = 10.1212/WNL.0000000000002840 }}</ref>

Rapid spreading of the pain, bilateral involvement or simultaneous participation with other major nerve trunks (such as Painful Tic Convulsif of nerves V & VII or occurrence of symptoms in the V and IX nerves) may suggest a systemic cause. Systemic causes could include multiple sclerosis or expanding cranial tumors.<ref name="Okeson 2005 453">{{cite book| vauthors = Okeson JP |title=Bell's orofacial pains: the clinical management of orofacial pain|year=2005|publisher=Quintessence Publishing Co, Inc|isbn=0-86715-439-X|page=453|chapter-url=http://www.quintpub.com/display_detail.php3?psku=B439X|editor=Lindsay Harmon|chapter=17|url-status=live|archive-url=https://web.archive.org/web/20140112055333/http://www.quintpub.com/display_detail.php3?psku=B439X|archive-date=2014-01-12}}</ref>

The severity of the pain makes it difficult to wash the face, shave, and perform good oral hygiene. The pain has a significant impact on activities of daily living especially as those affected live in fear of when they are going to get their next attack of pain and how severe it will be. It can lead to severe depression and anxiety.<ref name="SmithElias2013">{{cite journal | vauthors = Smith JG, Elias LA, Yilmaz Z, Barker S, Shah K, Shah S, Renton T | title = The psychosocial and affective burden of posttraumatic neuropathy following injuries to the trigeminal nerve | journal = Journal of Orofacial Pain | volume = 27 | issue = 4 | pages = 293–303 | year = 2013 | pmid = 24171179 | doi = 10.11607/jop.1056 | doi-access = free }}</ref>

However, not all people will have the symptoms described above; there are variants of TN, one of which is [[atypical trigeminal neuralgia]] ("trigeminal neuralgia, type 2" or trigeminal neuralgia with concomitant pain),<ref name=OHSU>{{cite web|url=http://www.ohsu.edu/facialpain/facial_pain-dx.shtml|archive-url=https://web.archive.org/web/20040625061701/http://www.ohsu.edu/facialpain/facial_pain-dx.shtml|url-status=dead|archive-date=June 25, 2004|title=Neurological surgery: facial pain|publisher=Oregon Health & Science University|access-date=2011-08-01}}</ref> based on a recent classification of facial pain.<ref name=Burchiel2003>{{cite journal | vauthors = Burchiel KJ | title = A new classification for facial pain | journal = Neurosurgery | volume = 53 | issue = 5 | pages = 1164–1167 | date = November 2003 | pmid = 14580284 | doi = 10.1227/01.NEU.0000088806.11659.D8 | s2cid = 33538452 }}</ref> In these instances there is also a more prolonged lower severity background pain that can be present for over 50% of the time and is described more as a burning or prickling, rather than a shock.

Trigeminal pain can also occur after an attack of herpes zoster. Post-herpetic neuralgia has the same manifestations as in other parts of the body. [[Ramsay Hunt syndrome type 2|Herpes zoster oticus]] typically presents with inability to move many facial muscles, pain in the ear, taste loss on the front of the tongue, dry eyes and mouth, and a vesicular rash. Less than 1% of varicella zoster infections involve the facial nerve and result in this occurring.<ref>{{cite journal | vauthors = Feller L, Khammissa RA, Fourie J, Bouckaert M, Lemmer J | title = Postherpetic Neuralgia and Trigeminal Neuralgia | journal = Pain Research and Treatment | volume = 2017 | pages = 1681765 | year = 2017 | pmid = 29359044 | pmc = 5735631 | doi = 10.1155/2017/1681765 | doi-access = free }}</ref>

Trigeminal deafferentation pain (TDP), also termed [[anesthesia dolorosa]], or colloquially as '''phantom face pain''', is from unintentional damage to a trigeminal nerve following attempts to fix a nerve problem surgically. This pain is usually constant with a burning sensation and numbness. TDP is very difficult to treat as further surgeries are usually ineffective and possibly detrimental to the person.<ref>{{cite web | url=https://www.facepain.org/understanding-facial-pain/diagnosis/anesthesia-dolorosa/ | title=Anesthesia Dolorosa | date=14 April 2021 | work = The Facial Pain Association }}</ref>