Trigeminal neuralgia (and it's also known by an acronym: TN) is a rare affliction characterized by pain on the face. It's usually one half of the face or the other half of the face. Usually these episodes of pain are shock-like, they're intense, people don't know why they're experiencing this pain. They will seek medical attention and it's rare enough of a disorder that many times we don't get the diagnosis until weeks or months later. But it's an important diagnosis to make because there is good treatment for it once you identify the diagnosis correctly.
Trigeminal neuralgia type 1 is a rare disorder, but it's a very, very important disorder for both patients and doctors to recognize because without treatment it's a horrible affliction, but with treatment the pain can either be made to go away or we can in some cases cure people of this disorder. The main things about trigeminal neuralgia type 1 are these episodes of sharp or shock-like pain in either one half of the face or the other. In between the pain, there's no pain and these painful episodes can usually be triggered by touching the face or talking or swallowing. If you have any of these symptoms, the right answer really is to find a practitioner who's comfortable and confident in treating this disorder, and those practitioners are usually neurologists or neurosurgeons. The treatment for this typically is either medication at the onset and later (if the problem becomes poorly managed with medication) there are surgical options or radiation options that can treat this effectively.
We split trigeminal neuralgia into two types. There's TN type 1 and there's TN type 2. They're vastly different. In TN type 1, patients experience this shock-like pain, but in between the episodes of pain, they are pain-free. The shock-like pain might last for seconds, maybe a few minutes - rarely longer than that, but the important thing is: in between the pain episodes, the patient is completely free of pain. In trigeminal neuralgia type 2, the situation is completely different. The pain on the face is more like a dull aching pain and the other thing is: it doesn't seem to go away. Maybe it gets better at times, maybe it gets worse at times, but it doesn't go away. That's how you can tell the difference clinically between trigeminal neuralgia type 1 and type 2. The reason it's so important is the treatments are so vastly different between the two types of trigeminal neuralgia.
Trigeminal neuralgia type 1 is a rare disorder and we see about 5-10 new cases every 100,000 people. If you take a city like Tucson that has got about a million people, you're looking at 50-100 new cases each year. That may seem like a lot, but when you put that in perspective, that means any given primary care physician may go years without ever seeing a case, and so its rarity makes it sometimes very difficult to diagnose because people on the front lines don't see it that often.
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