Trigeminal Neuralgia: What You Need to Know
Trigeminal neuralgia most frequently affects people older than 50, and the condition is more common in women than men.
Trigeminal neuralgia is the most common cause of facial pain and is diagnosed in approximately 15,000 people per year in the United States.
Trigeminal neuralgia pain is exceptionally severe. Although the condition is not life-threatening, the intensity of the pain can be debilitating.
Trigeminal neuralgia relief is possible: Medical and surgical treatments can bring the pain under control, especially when managed by an expert physician and surgeon.
Trigeminal neuralgia is a condition characterized by pain coming from the trigeminal nerve, which affects the face — most commonly one side of the jaw or cheek.
The pain of trigeminal neuralgia is unlike facial pain caused by other problems. It is often described as stabbing, lancinating or electrical in sensation and so severe that the affected person cannot eat or drink.
Trigeminal neuralgia is sometimes known as tic douloureux, which means “painful tic.”
Causes of Trigeminal Neuralgia
Trigeminal neuralgia may be caused by a blood vessel pressing against the trigeminal nerve. Over time, the pulse of an artery rubbing against the nerve can wear away the insulation, which is called myelin, leaving the nerve exposed and highly sensitive.
These symptoms can be similar to those caused by dental problems, and sometimes people with undiagnosed trigeminal neuralgia explore multiple dental procedures in an effort to control the pain.
Trigeminal Neuralgia Symptoms
Episodes of sharp, stabbing pain in the cheek or jaw that may feel like an electric shock
Pain episodes that may be triggered by anything touching the face or teeth, including shaving, applying makeup, brushing teeth, eating, drinking or talking — or even a light breeze
Periods of relief between episodes
Anxiety from the thought of the pain returning
A flare-up of trigeminal neuralgia may begin with tingling or numbness in the face. Pain occurs in intermittent bursts that last anywhere from a few seconds to two minutes, becoming more and more frequent until the pain is almost continuous.
Flare-ups may continue for a few weeks or months followed by a pain-free period that can last a year or more.
Trigeminal Neuralgia Diagnosis
Diagnosing trigeminal neuralgia involves a physical exam and a detailed medical history to rule out other causes of facial pain. The health care provider will ask what the pain is like, what seems to set it off and what makes it feel better or worse.
The provider may recommend imaging or laboratory tests to determine if the pain is caused by a tumor or blood vessel abnormality or by undiagnosed multiple sclerosis. Certain advanced MRI techniques may help the doctor see where a blood vessel is pressing against a branch of the trigeminal nerve.
Treatment for Trigeminal Neuralgia
Most common over-the-counter and prescription pain medicines don’t work for people with trigeminal neuralgia, but many modern treatments can reduce or eliminate the pain. The doctor may recommend one or more of these approaches:
Medications: Seizure drugs like carbamazepine, gabapentin or other agents can be helpful. It is important to work closely with a neurologist or primary care provider to monitor dosages and side effects.
Surgery: Several procedures can often help bring trigeminal neuralgia pain under control.
There are several kinds of rhizotomies, which are all outpatient procedures performed under general anesthesia in the operating room. The surgeon inserts a long needle through the cheek on the affected side and uses an electrical current or a chemical to deaden the pain fibers of the trigeminal nerve.
Stereotactic radiosurgery, sometimes known as CyberKnife treatment, is another outpatient procedure that involves a very concentrated and precise beam of radiation that is directed at the trigeminal nerve to relieve the pain.
Microvascular Decompression (MVD) Surgery
This procedure is currently regarded as the most long-lasting treatment for trigeminal neuralgia and may be suitable for people in good health who can tolerate surgery and general anesthesia and whose lifestyles can accommodate a recovery period of four to six weeks.
The surgeon makes an incision behind the ear and removes a small piece of the skull to gain access to the nerve and blood vessels. Then, the surgeon places a cushion of insulation around the blood vessel so it no longer compresses or rubs against the nerve.
In about one third of people treated with MVD surgeries, trigeminal neuralgia pain returns, possibly due to the blood vessels growing back. The doctor will help individuals with recurring pain choose other options or may recommend repeating procedures.
Managing Trigeminal Neuralgia
Although not fatal, trigeminal neuralgia pain and the anxiety it causes can erode a person’s quality of life. It is essential to work closely with experienced and compassionate health care providers who can help find the best therapeutic approach for each individual.
The surgery for trigeminal neuralgia is delicate and precise since the involved area is very small. Look for experienced neurosurgeons who see and treat a large number of people with trigeminal neuralgia.
Trigeminal Neuralgia Surgery | Michelle's Story
Michelle's debilitating facial pain from trigeminal neuralgia prevented her from working, speaking with friends and family, and simple pleasures like cooking and cycling with her husband. Watch as her life has turned around following microvascular decompression surgery by Dr. Michael Lim.
Trigeminal Neuralgia: Frequently Asked Questions
Johns Hopkins neurosurgeon Michael Lim answers commonly asked questions about trigeminal neuralgia, including its symptoms, how it’s diagnosed and the possible treatment options.