Case: A 68 year old man's birthday dinner was ruined (at least for him) when he chewed a steak and got a knife-like pain in his face, under his right cheek. The pain lasted only a minute. A while after it subsided, he very carefully went back to his steak, now cool, chewing only on his left side back teeth. He tried to smile for his hosts, but the memory of the pain lingered.
He thought he might have split a tooth, although examining his teeth with his tongue did not reveal any cracks or wobbliness. The next day he visited his dentist, who found no problems.
He was relieved he wouldn't have the pain and expense of a dental extraction. Still, the pain had been severe, and, not knowing its cause, it could recur, he thought.
It did. This time, not from chewing, but from stroking his cheek as he thought about a shopping decision. "Ouch!" he winced and scrunched his eyes closed. Again, the pain lasted only a few minutes, then subsided.
It went on this way, sometimes days between episodes. He found different "triggers" might cause the pain: chewing, touching his cheek, shaving on that side, brushing his teeth, even smiling. Fear of the pain made him stop smiling completely, worrying his wife and family. He could not sleep on his right side, because pressure from the pillow could trigger the pain.
He visited his doctor, who suggested "tic douloureux". But the man protested, saying he had not been bitten by a tick, or even been around ticks for several months.
Defining "Tic Douloureux"
His doctor explained the condition. First, she told him how to pronounce it. "TIK-doo-lah-roo," she instructed him. (Later, he learned it is better pronounced, "TIK-dowler-row," and the French often say, "TIK- duhruh." It's from French where it means a twitch (tic) that is painful.
It's a syndrome, meaning it's a set of signs and symptoms that are defined, but the cause is not necessarily known, or it can be due to several different abnormalities.
It's also called "trigeminal neuralgia," because it is pain (-algia) related to the trigeminal nerve. (The trigeminal nerve is so-called because it forks into three smaller nerves, or branches.)
What Causes Tic Douloureux or Trigeminal Neuralgia?
Most commonly it is felt to be something pressing on the trigeminal nerve as it courses out of the skull. The pressure lowers the nerve's stability, and it sends a pain signal back to the brain. Problems that can cause pressure on the trigeminal nerve include congenital variations, blood vessel inflammation, and trauma. Tic douloureux is generally considered a neuropathy.
Non-tic Douloureux Causes of Facial Pain
Some conditions that may cause similar pain include:
- a tumor, benign or malignant
- stroke
- multiple sclerosis
- new blood vessel malformation.
Atypical migraine can cause face pain, but the pain usually lasts longer, and occurs in a person known to have migraine pain.
Dental abscess in an upper tooth can cause face or cheek pain. Sinus infection is another condition that causes face pain. These conditions generally cause pain that lasts longer than a few minutes.
Shingles is a fairly common cause of facial pain. Shingles on the face is especially critical to diagnose, as shingles in the eye can cause blindness.
Face pain can be a serious condition and requires a professional examination and diagnosis. If it turns out to be tic douloureux, the good news is it's not likely to be fatal; the bad news is it will be around for a while.
Sources
The Merck Manual, 18th edition. Merck Research Laboratories 2006
Krafft RM: Trigeminal Neuralgia . American Family Physician. 2008 May 1;77(9):1291–6.
James Cooper - I'm on the faculty of a health science department at a large university. Most of my articles derive from conferences or presentations ...
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