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​​What is trigeminal neuralgia?

Trigeminal neuralgia is a chronic pain condition that affects the trigeminal nerve which carries sensation from your face to your brain. 

 


What causes trigeminal neuralgia?

In trigeminal neuralgia, the nerve's function is disrupted. Usually, the problem is contact between a normal blood vessel, an artery or a vein, and the trigeminal nerve and causes it to malfunction. Trigeminal neuralgia can occur as a result of aging, or it can be related to multiple sclerosis or a similar disorder that damages the myelin sheath protecting certain nerves. Less commonly, trigeminal neuralgia can be caused by a tumor compressing the trigeminal nerve.

A variety of triggers may set off the pain of trigeminal neuralgia including:

  • Shaving
  • Touching your face
  • Eating
  • Drinking
  • Brushing your teeth
  • Talking
  • Putting on makeup
  • Encountering a breeze
  • Smiling
  • Washing your face

 


What are the symptoms of trigeminal neuralgia?

Trigeminal neuralgia symptoms may include one or more of these patterns:

  • Episodes of severe, shooting or jabbing pain that may feel like an electric shock
  • Spontaneous attacks of pain or attacks triggered by things such as touching the face, chewing, speaking and brushing teeth
  • Fits of pain lasting from a few seconds to several minutes
  • Episodes of several attacks lasting days, weeks, months or longer. Some patients have periods when they experience no pain
  • Constant aching, burning feeling that's less intense than the spasm-like pain
  • Pain in areas supplied by the trigeminal nerve, including the cheek, jaw, teeth, gums, lips or less often the eye and forehead
  • Pain affecting one side of the face at a time though may rarely affect both sides of the face
  • Pain focused in one spot or spread in a wider pattern
  • Attacks that become more frequent and intense over time

 


How is trigeminal neuralgia diagnosed?

Your physician will diagnose trigeminal neuralgia based on your description of the pain you're having which includes:

  • Type; pain related to trigeminal neuralgia is sudden, shock-like and brief.
  • Location; the parts of your face that are affected by pain will tell your physician is the trigeminal nerve is involved.
  • Triggers; trigeminal neuralgia-related pain is usually brought on by light stimulation of your cheeks, for example from eating, talking or even encountering a cool breeze.

Your physician may conduct many tests to diagnose trigeminal neuralgia and determine underlying causes for your condition. These tests can include a neurological exam to touch and examine parts of your face to help determine exactly where the pain is occurring and if you appear to have trigeminal. Reflex tests can also help your physician determine if your symptoms are caused by a compressed nerve or another condition. Your physician may order an MRI scan of your head to determine if multiple sclerosis or a tumor is causing trigeminal neuralgia. In some cases, a dye may be injected into a blood vessel to view the arteries and veins and highlight blood flow.

 


How is trigeminal neuralgia treated?

Trigeminal neuralgia treatment usually starts with medications. Other patients do not respond to medications or may experience side effects, so injections or surgery are other treatment options. 

Medications will lessen or block the pain signals sent to your brain and include Anticonvulsants, Antispasmodic agents (muscle relaxing agents) or botox injections. Always consult your physician for the medication that's best for you.

The goal of trigeminal neuralgia surgery is to stop the blood vessel from compressing the trigeminal nerve or damage the nerve to keep it from malfunctioning. Damaging the nerve often causes temporary or permanent facial numbness, and with any of the surgical procedures, the pain can return months or years later.

Surgical options include:

  • Microvascular decompression; this involves relocating or removing blood vessels that are in contact with the trigeminal root. During microvascular decompression, an incision is made behind your ear on the side of your pain. Through a small hole in your skull, your surgeon moves any arteries that in contact with the trigeminal nerve away from the nerve, and place a pad between the nerve and the arteries. If a vein is compressing the nerve, your surgeon may remove it. Microvascular decompression can successfully eliminate or reduce pain most of the time, but pain can return in some cases. 
  • Gama Knife radiosurgery; your surgeon directs a focused dose of radiation to the root of your trigeminal nerve; radiation is used to damage the trigeminal nerve and reduce or eliminate pain. Relief occurs gradually and may take several weeks. Gamma Knife radiosurgery is successful in eliminating pain for the majority of patients. If pain returns. The procedure can be done again. 
  • Glycerol injection; your surgeon inserts a needle through your face into an opening in the base of your skull; the needle is guided into the trigeminal cistern, a small sac of spinal fluid that surrounds the trigeminal nerve ganglion where the trigeminal nerve divides into three branches and part of its root. A small amount of sterile glycerol is injected which damages the trigeminal nerve and blocks pain signals. The procedure often relieves pain, but some patients have a later recurrence of pain, and many experience facial numbness or tingling.
  • Balloon compression; your physician inserts a hollow needle through your face and guides it to a part of your trigeminal nerve that goes through the base of your skull. A catheter with a balloon on the end is guided through the needle so that the balloon inflates with enough pressure to damage the trigeminal nerve and block pain signals. Balloon compression successfully controls pain in most patients for a period of time. Patients who have this procedure done experience some facial numbness, and some experience temporary or permanent weakness of the muscles used to chew.
  • Radiofrequency thermal lesioning; nerve fibers associated with pain are selectively destroyed. Your surgeon inserts a hollow needle through your face while you are sedated and guides it to a part of the trigeminal nerve that goes through an opening at the base of your skull. Once the needle is positioned, you will be awakened from sedation, while your surgeon inserts an electrode through the needle and sends a mild electrical current through the top of the electrode. You'll be asked to indicate when and where you feel tingling. When the part of the nerve associated with your pain is located, you are sedated again. The electrode is then heated until it damages the nerve fibers, creating an area of injury. If your pain is not eliminated, your physician may create an additional lesion. Radiofrequency thermal lesioning usually results in some temporary facial numbness after the procedure.

Please talk to your physician or schedule a consultation to determine what is best for you.