Just wondering if anyone knows why some of us get Type2 (Atypical) after weve had TN1

Hi all, i was just wondering if anybody knows why some of get Type 2 Atypical after we have had Type 1, What happens to cause us to get the Type 2, and not just stay with Type 1. I had an MVD done last August, My TN1 pain started again within a week or two , but by Christmas it has changed to TN2, When i saw my Neurosurgeon, he said that i now had Type 2 Atypical. I still get the occasional zapping from TN 1, so can not say that has gone completley.

I am just curious to know, if any one has any information it would be great to hear there opinion. I have asked this in the "Type II Trigeminal Neuralgia Discussions Board" but only got 1 reply so thought i would ask again here just incase any one else had any ideas besides elstep.

Thanks Nita x

But why does one turn into the other? Or why does Type 2 develop after type 1 and you end up with both?

Medications changed my pain from classic TN1 with electric shocks to pain that is described as "atypical." However, if I miss a couple of doses of meds, the pain quickly reverts back to the original TN1. I've also discovered that with different meds, I get different kinds of pain. For example, tegretol minimizes pain to a deep dull ache. With gapapentin, the pain is a radiating, stabbing, trobbing type of pain. Both are more tolerable than TN1 pain.

Nanci My type 2 is also much more tolerable then then awful TN1 electric shocks. Although I know for some people Type 2 is intolerable, there are so many different degrees of pain to type 2.

here is the most widely accepted medical theory as to why classic TN pain transforms into something less typical:

when a vascular compression is occurring on trigeminal nerve, it takes time for the myelin sheath (the protective coating on the nerve) to wear down. the electric zaps occur when the myelin is worn thin enough to lose its protection for the nerve. myelin rebuilds itself over time; however, this is a process which is individual based on a host of factors; age, overall health, age, and some people believe, gender. the remissions from pain happen when the myelin has repaired itself enough so that the nerve is insulated well enough from the ectopic signals the vascular compression provokes from the nerve.

over time, the myelin loses its ability to repair itself well enough to protect the nerve from the compression. this is the point where some medical professionals believe the pain transforms into atypical, or TN2. the constant pain is a result of the constant compression, coupled with little to no myelin sheath on the nerve. the zaps still occur due to the electrical signal provoked by the compression on the nerve. the constant ache is because the nerve is being compressed by something. in cases of severe tortuous compressions, the inside of the nerve can be compromised.

a variant explanation: some people have veins compressing their nerves instead of blood vessels. veins do not pulsate like vessels, so there is no ectopic signal being provoked by the nerve to cause the zaps. over time, the compression still wears down the sheath, and you are left with the constant pain symptoms.

there is also the lesser cases of tumors, brain injuries and anatomical derangements to account for pain symptoms, so be sure to have an MRI to rule these things out.

hope this helps,


Thank you Vesper foryour answer,

Hi Cleo, After my MVD, My Surgeon said, that i had a network of veins like a netting, that he had problems getting through before he could get to the Nerve. Also when he did manage to get through to the nerve, he did not have enough room to put any Teflon in , and had to try and cauterize the artery ?? ( the one that pulsates).. that was pressing on the Trigeminal Nerve. But he was only partially succesfull in doing this. Sorry i always get mixed up between the veins and arteries, but it was the one that pulsates that he had problems with. He also cut the muscles in my neck to try and get where he wanted to go as in his words

"It was such a mess in there !!", so my scar is a lot lower down than a lot of peoples i have seen pictures of.

Thanks Nita xx

Cleo said:

One is caused by vascular compression the other is caused by unknown origin in the majority of most cases. what was found during your mvd?