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Trigeminal Neuralgia - Facial Pain

What is trigeminal neuralgia/facial pain?
Trigeminal neuralgia is a disorder of a nerve that normally supplies feeling to the face with a syndrome of one-sided shooting facial pain. This nerve – the trigeminal nerve (5th cranial nerve) – branches into three divisions as it leaves the skull, one supplying sensation to the forehead, one to the cheek, and one to the lower jaw. Any or all of the three divisions may be affected.

What are the symptoms of trigeminal neuralgia?
Symptoms of trigeminal neuralgia are usually zapping, shooting, or excruciating spasms of facial pain. They may occur in repetitive attacks lasting only a few seconds. The pain may be so severe that the patient may cry out or visibly wince. The affected area of the face may become super-sensitive, with such minor stimulation as a light breeze, cold temperature, water from a shower, washing the face, shaving, or even eating can set off attacks of pain.

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What causes trigeminal neuralgia?
A variety of conditions that irritate the nerve can lead to this painful disorder. Sometimes a small loop of a blood vessel outside the brain can press against the nerve. In young patients, multiple sclerosis can be a cause, affecting the nerve as it leaves the brain. There are several other inflammatory conditions that may damage the nerve or the brainstem where it originates. Initial workup usually includes an MRI scan of the brain, given with an intravenous contrast dye. Most often, there are no abnormalities found on testing. It is possible that in some cases the condition can be started by a virus affecting the nerve.

In unusual cases, there may be an underlying constant pain of a different quality. These cases of atypical facial pain are more difficult to treat.

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How is trigeminal neuralgia treated?
There are several treatment options, including medications to reduce nerve pain. For many patients, however, medication alone is not sufficient to control their symptoms, or side effects are not tolerable. For patients who are not responding well to medications, there are various techniques from carefully guided needle injections to targeted radiation therapy that can be used to partially eliminate the irritated nerve.

While many patients do well with these procedures, there is some risk of resulting facial numbness. For appropriate patients desiring a “definitive” treatment without complications of facial numbness, surgery to find and remove the blood vessel pressing against the nerve can be curative.

We work closely with the surgeons of the Johns Hopkins Trigeminal Neuralgia Center. The Johns Hopkins Headache Center emphasizes non-surgical management, and helps evaluate the more complex or atypical cases for appropriate interventions.

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