Does Trigeminal Neuralgia Cause Headaches & Can It Affect The Eye?

Does Trigeminal Neuralgia Cause Headaches?

The trigeminal nerve has three components: – ophthalmic branch, maxillary branch, and mandibular branch. It is also known as Tic Douloureux. It is a disease presenting with sharp, shooting, stabbing facial pain with spasms and tics. Exclusive involvement of only one branch is rarely seen instead the pain radiates from one branch to another and involvement of maxillary and mandibular branches and their junction is commonly seen in it. The involvement of the ophthalmic branch of the trigeminal nerve is rarely seen which according to a data is nearly 5%. But the involvement of the ophthalmic branch can commonly lead to symptoms of eye pain and headache.[1]

It may present with few other symptoms like headache, sinus pain, eye ache, pain behind the eye, etc. Although these are not so commonly encountered symptoms they are likely to found in atypical cases. Due to the supply of trigeminal nerve in the scalp region to an extent and on the forehead by ophthalmic branch, the scalp and the forehead painful area may mimic the symptom of headaches. It can difficult at times to differentiate the pain from scalp tenderness or the headache. Some of the causes of the trigeminal neuralgia include multiple sclerosis, vascular compressions, intracranial tumors, metastasis in the brain and other space-occupying lesions which can lead to various symptoms like headache, vomiting, nausea, etc. but headache being the most common one amongst them.

Can Trigeminal Neuralgia Affect The Eye?

Also due to the supply of the same branch to the supraorbital area and small area around the eye, it can present as eye pain or retro-orbital pain (pain behind the eye). Sometimes the ophthalmic branch involvement can also lead to involuntary blinking movements of the eyelids which may be unilateral or bilateral. In severe cases of involvement of trigeminal nerve, redness of the eye, blurring of vision, watering from eyes, severe eye pain, etc. can accompany the other characteristic features of trigeminal neuralgia.

In cases of syndromes with multiple nerve involvements where other cranial nerves like third, fourth and sixth cranial nerves are also involved like Tolosa Hunt Syndrome, superior orbital syndrome, etc. it can present as paralysis of eye muscles and difficulty in movement of the eyes, nystagmus, squint, etc. Many times it is associated with vascular compressions like in cavernous sinus thrombosis etc. where it could cause pulsating exophthalmos with retrobulbar pain. Various intracranial space occupying lesions can also push the eyeball along with compressing upon 5th cranial nerve producing features related to the eye. These features are rare but usually come as unilateral involvement.

To find out and diagnose the causes of such uncommon involvement in trigeminal neuralgia, various investigations like magnetic resonance imaging can be performed to rule out the intracranial causes. Vascular pathologies are very well seen on angiography like aneurysms, dilatation of vessel, dural venous sinuses enlargement, etc. Investigation of Cerebrospinal fluid and its assessment can diagnose conditions like multiple sclerosis, metastasis of brain, lymphoma of the brain, etc. which can all be causes of headache and other uncommon symptoms of trigeminal neuralgia.

Conclusion

Although, the trigeminal neuralgia has got a typical presentation in the clinical scenario atypical presentations are also not very uncommon. These causes can be ranging from the most simple presentation of the disorder to the most dangerous complications of some underlying pathology. The ophthalmic branch involvement is mostly the culprit in the atypical presentation of trigeminal neuralgia. Headache and eye symptoms can be seen in a few cases and are a part of the whole syndrome of involvement of the trigeminal nerve. But common causes of involvement of eyes in the trigeminal nerve include multiple cranial nerve involvement disorders whereas headache is more common in intracranial causes. The ophthalmic branch involvement is having a slightly poorer prognosis than the other two branches involvement. Medical treatment is usually sufficient for the treatment of this disorder but surgical treatment could be used as a onetime treatment with favorable success rate.

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