The following is a guest opinion article from Doc Martyn. His opinions and advice are entirely his own and may not necessarily be those of The  Pattaya News Company Limited. His contact information can be found at the end of the article.
Medical Bytes Thailand no 114:Â âTic Douloureuxâ
- At the behest of a friend, Mark, a healthy 59-year-old Pom who runs a bar in Soi 7 Pattaya, came to see me 3 days ago. For the previous 2 months, he had suffered frequent intermittent severe burning pain in his jaw and left temple. Each attack would last 5-10 minutes, occurring randomly as much as 2-3 times per day. In addition, he suffered numbness in his left forearm.
- He had seen a doctor at the International Hospital, Pattaya who prescribed a series of pills for his headache. When his suffering continued, he attended a private medical clinic in Pattaya, the doctor suggested an MRI brain scan, which Mark did not want and could not afford.
- We discussed his symptoms. His burning (as âon fireâ) pain was typical of neuralgia, pain emanating from a nerve. His symptoms were characteristic of Trigeminal Neuralgia, a terribly painful illness which, during an attack, immobilizes the sufferer. The Trigeminal nerve is responsible for facial sensation and motor functions, like chewing. Markâs pain distribution, from his jaw to his temple, was typical of neuralgia in the 3rd branch, the mandibular branch, of his Trigeminal nerve, see photos 1 and 2.
- The Trigeminal Nerve is number 5 of 12 cranial nerves that innervate the head, see photo 3. Cranial nerves differ from the other nerves of the body. They emerge directly from the skull on the ipsilateral, same, side of the body. All other nerves travel down the spine where they cross over and supply the contralateral, the opposite, side of the body. As medical students, we used to use mnemonics to remember names. Our Mnemonic for the 12 cranial nerves was To Take Advantage oF Virgins Gives Vic A Hernia, which translates to: The Ophthalmic, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Vestibulocochlear, Glossopharangeal, Vagus, Accessory, Hypoglossal nerves. Who said medical school wasnât fun!
- The treatment for Trigeminal Neuralgia is Tegretol, Carbamazepine, which I prescribed for Mark. Up to 90% of patients will respond to this treatment. There are other medications that may be used if the Tegretol fails to work. If the neuralgia does not settle then surgery may be considered. The surgery is complicated. The success rate is 75%. Mark has been pain-free since starting the Tegretol.
- Regarding Markâs paraesthesia in his left forearm; he had a C6 radiculopathy in his arm, the equivalent of sciatica in the leg. I injected his neck with a steroid to reduce the inflammation around his exiting C6 nerve root.
- This Byte sounds simple and straightforward. It is not. Fortunately, Mark sought my opinion early, which rendered the treatment more effective. Trigeminal Neuralgia is also known as Fothergill disease, after the Yorkshire doctor who first described it in the 1700s, Trifacial neuralgia, Tic Douloureux, and Suicide Disease. The pain caused by Trigeminal Neuralgia is akin to torture. Evard Munchâs painting âThe Screamâ, see photo 4, has been used to illustrate the severity of the suffering of these patients.
- I recall the term Tic Douloureux from medical school. It is the French name for Trigeminal Neuralgia. The English translation is âpainful ticâ. What is it with the French? This disease is so painful it is called the Suicide Disease. âTic Douloureuxâ itâs far worse than a painful tic.
Addendum: Over the past 6 years, as a retired medic living in Buriram I offered second opinions on any medical issue. I recently moved to Pattaya. As in this case, if you reside outside of Pattaya, telephone consultations are provided. For assistance; please contact me, Doc Martyn, on Facebook or call Dao on 095 414 8145.