What is trigeminal neuralgia?
Trigeminal neuralgia is a chronic pain that affects the trigeminal nerve, which carries sensation signals from the face to the brain. If you have trigeminal neuralgia, a slight stimulation to the face – such as brushing your teeth or applying makeup – can cause an intense pain attack.
At first, you may experience short, mild attacks. But trigeminal neuralgia may progress to more frequent and longer episodes of severe pain. Trigeminal neuralgia affects more women than men, and its incidence usually increases in the older age group of 50 years.
There is a multitude of treatment options available. Doctors usually treat trigeminal neuralgia effectively with medications, injections, and surgery.
Symptoms of trigeminal neuralgia may include one or more of these patterns:
- Severe episodes of pain and tingling that resemble an electric shock.
- Successive episodes of pain are caused by actions such as touching the face, chewing, talking or brushing teeth.
- Constant episodes of pain that range from a few seconds to a few minutes.
- A series of multiple attacks that last for days, weeks, months, or more.
- A feeling of constant itching or burning sensation before it develops into trigeminal neuralgia.
- Pain in areas where the trigeminal nerve runs through, including the cheek, jaw, teeth, gums, and lips, or less often in the eyes and forehead.
- The pain sometimes affects one side of the face, but it rarely affects both sides of the face.
- The pain is concentrated in one point or spreads in a horizontal scale.
- In trigeminal neuralgia, the trigeminal nerve is disrupted. This usually occurs when there is a contact between a normal blood vessel and the trigeminal nerve at the base of your brain. This contact puts pressure on the nerve, causing it to malfunction.
- Trigeminal neuralgia can occur as a result of aging, or it can be caused by multiple sclerosis, or a similar disorder that damages the myelin sheath that protects some nerves. Trigeminal neuralgia can also be caused by a compressive tumor on the trigeminal nerve.
- Some people may experience trigeminal neuralgia because of a brain lesion or other abnormalities. In other cases, surgical injuries, a stroke, or any trauma to the face may be responsible for the trigeminal neuralgia.
Triggers of trigeminal neuralgia pain include:
- Shaving
- Touching the face
- Eating or drinking
- Washing your face
- Brushing your teeth
- Talking
- Putting on makeup
- Smiling
Our neurologist will diagnose trigeminal neuralgia primarily based on your description of the pain, including:
- Type. The pain associated with trigeminal neuralgia is sudden, shock-like, and short-lived.
- Site. The parts of your face affected by pain will let your doctor know if the trigeminal nerve is responsible.
- Causes. Trigeminal pain usually occurs when there is mild stimulation, such as eating, talking, or even when exposed to a cold breeze.
Your doctor may perform several tests to diagnose trigeminal neuralgia and determine the underlying causes of your condition, including:
- A neurological examination. Touching and examining parts of your face can help your doctor determine exactly where the pain is occurring and – if it appears you have trigeminal neuralgia – they can identify which branches of the trigeminal nerve are affected.
Magnetic resonance imaging (MRI). Your doctor may order an MRI scan of your head to determine whether multiple sclerosis or a tumor is causing trigeminal neuralgia.
How is trigeminal neuralgia treated?
Trigeminal neuralgia treatment usually starts with medication, and some people do not need any additional treatment. However, some people with the condition may stop responding to medications over time, or they may experience bad side effects. Injection or surgery provides other treatment options for trigeminal neuralgia.
Medications
To treat trigeminal neuralgia, your doctor will usually prescribe medications to reduce or block the transmitted pain signals.
- Anticonvulsants. Doctors usually prescribe carbamazepine for trigeminal neuralgia, and it has been shown to be effective in treating the condition. If the anticonvulsant you are using begins to lose effectiveness, your doctor may increase the dose or switch to another type.
- Antispasmodic agents. Muscle relaxing agents such as baclofen may be used alone or in combination with carbamazepine.
- Botox injections. Some studies have shown that injections of botulinum toxin (Botox) may reduce pain in trigeminal neuralgia in people who are no longer helped by medications.
Surgery
- Relieving pressure on small blood vessels. This procedure involves repositioning or removing the blood vessels that come into contact with the trigeminal nerve root to prevent disruption of the nerve. While relieving pressure on small blood vessels, your doctor makes an incision behind the ear on the side that hurts. Then your surgeon moves, through a small opening in your skull, any arteries touching the trigeminal nerve away from the nerve and places a soft lining between the nerve and the arteries.
- Brain stereotactic radiosurgery (Gamma Knife). In this surgery, a surgeon directs a focused dose of radiation to your trigeminal nerve root. This surgery uses radiation to destroy the trigeminal nerve and reduce or eliminate pain. Recovery occurs gradually and may take up to a month.
- Glycerol injection. During this procedure, your doctor inserts a needle through your face into an opening in the base of your skull. Your doctor directs the needle into the trigeminal cistern, a small sac of cerebrospinal fluid that surrounds the trigeminal ganglion – where the trigeminal nerve divides into three branches – and part of its root. Then your doctor will inject a small amount of sterile glycerol that damages the trigeminal nerve and blocks pain signals.
- Balloon compression. In this procedure, your doctor inserts a hollow needle through your face and guides it to the part of your trigeminal nerve that runs through the base of your skull. Then your doctor guides a thin, flexible tube (catheter) with a balloon at its tip through the needle. Your doctor inflates the balloon with enough pressure to destroy the trigeminal nerve and block pain signals.
