FAQs on Trigeminal Neuralgia

What is Trigeminal Neuralgia?

Trigeminal neuralgia is one of the most common facial pain conditions. A neuropathic disorder leading to extreme painful sensation in the fifth cranial nerve, also known as trigeminal nerve, it occurs more in women and people above 60 years of age. The International Association for the Study of Pain described the problem as “sudden, usually unilateral, severe, brief stabbing or lancinating, recurrent episodes of pain in the distribution of one or more branches of the trigeminal nerve.”

The trigeminal nerve, a widely distributed nerve, is responsible to transmit sensations from all parts of your face to brain. When the nerve is compressed at a point, the pain syndrome starts with short, mild attacks in one part and spread to other nerve areas in the upper, middle, and lower face. As a result, patients also experience longer, repeated bouts of severe pain.

Trigeminal neuralgia attack goes on from seconds to a few minutes. The syndrome lasting in volleys may recur causing patients to suffer from facial pain in subsequent hours to weeks. It may not be repeated for years before making a return.

Patients with the disorder are so sensitive that even mild stimulation, such as facial make up, vibration, or brushing of teeth, may trigger burning or shock-like sensation that turn into excruciating pain. About 15,000 Americans are diagnosed with trigeminal neuralgia every year.

What causes trigeminal neuralgia?

Trigeminal neuralgia pain starts when there is disruption leading to erratic or hyperactive performance by the trigeminal nerve. The most common example is pressure caused by a blood vessel on the nerve.

It also results from damaged myelin sheath, a protective layer wrapped around nerves, or because of aging. Multiple sclerosis, tumors, brain lesions, and arteriovenous malformation in blood vessels may squeeze the nerve and create the painful disorder. Often facial stroke or oral surgery may impact the trigeminal nerve and trigger neuralgia.

What are the symptoms of trigeminal neuralgia?

A patient with following symptoms may have the trigeminal neuralgia disorder.

  • Pain in areas where trigeminal nerve has its spread
  • Frequent pain attacks in volleys that become more progressively intense
  • Mild, aching, and burning pain with episodic twinges at the onset
  • Bouts of severe, stabbing pain resembling electric shock
  • Sudden painful sensation when brushing teeth, massaging face, chewing, or eating
  • Pain episodes lasting between a few seconds to several minutes
  • Pain repeated after hours, days, or months
  • Intermission period extending from weeks to years between pain attacks
  • Pain starts at a side and radiates in a wider pattern
  • Facial pain while sleeping
  • Debilitating face pain not controlled with regular medications

Who is at risk of trigeminal neuralgia?

The disorder impacts mostly people over age 50. Females are found to be more susceptible to trigeminal neuralgia than their male counter parts. People with brain tumor or multiple sclerosis are also at the greater risk of suffering from this disorder.

How is trigeminal neuralgia diagnosed?

Dallas pain management doctors diagnose trigeminal neuralgia following assessment of physical and neurological symptoms and patient’s medical history. If the cause of pain is discovered, it is easier to distinguish it from cluster headaches, atypical headaches, jaw-related TMJ headaches, and herpetic neuralgia pain. MRI scan also helps find out nerve compressions caused by tumor or blood vessels.

The International Headache Society has suggested a check list to differentiate trigeminal neuralgia from migraine and postherpetic pain in the face. It includes,

  • sudden and uncontrolled pain attacks
  • pain in one or more areas where trigeminal nerve has its presence
  • intense, sharp, or stabbing pain
  • an episode of pain lasting up to two minutes at a stretch
  • pain without neurologic deficit
  • pain without any prior disorder and stereotyped in a patient

What are the treatment methods available for trigeminal neuralgia?

  • Medications

Patients with trigeminal neuralgia are treated with anticonvulsants, antispasmodic medicines or tricyclic antidepressants. Anticonvulsant drugs block the nerve sensations. However, many patients do not respond favorably to these drugs and are at the risk of side effects. The disorder also becomes drug resistant with time.

  • Surgical Intervention

Surgery is an option if trigeminal neuralgia patients suffer from bone marrow suppression, memory disorder, and cognitive disturbances and the pain becomes drug resistant. Microvascular decompression neurosurgery helps remove or relocate blood vessels compressing of the nerve by blood vessels. The root of trigeminal nerve and painful nerve fibers are blunted during the Gamma knife radiosurgery using radiation. An outpatient procedure, it impairs the nerve’s sympathetic actions.

Many patients undergo neurectomy and a section of nerve fibers is removed. However, surgery has the potential to damage trigeminal nerve and blood vessels that may lead to sensory disabilities or other adverse events. The pain may also return after a few years.

  • Non-Operative Pain Management

Trigeminal Nerve Block: A popular non-operative pain management, the procedure involves injections of local anesthetic and steroids under real-time x-ray to the trigeminal nerve ganglion. It numbs the nerve and reduces the inflammation at the trigger area. Such blocks remain effective for months to years without any major side effects.

Glycerol Injection: Sterile glycerol is injected into the trigeminal nerve ganglion, where the nerve separates into three divisions. It denerves the nerve and blocks transmission of pain signals to the brain.

Balloon Compression: A balloon is placed through a needle incision using a catheter. It is inflated with pressure to expand the squeezed area and then it is deflated and taken out. It offers up to two-year trigeminal neuralgia pain relief.

Radiofrequency Thermal Lesioning: It uses mild electrical current to damage nerve fibers and attain the desired sensory loss to inhibit the trigeminal neuralgia pain.

References

Mayo Clinic

Trigeminal Neuralgia Fact Sheet, NINDS. Publication date June 2013. NIH Publication No. 13-5116

Janneta, PJ. Microsurgical management of trigeminal neuralgia. Arch Neurol 1985; 42:800. Lance, JW. Mechanism of and management of headache, Butterworth Heinemann, Oxford 1993, p. 260.

Bagheri, SC; et al (December 1, 2004). “Diagnosis and treatment of patients with trigeminal neuralgia”. Journal of the American Dental Association 135 (12): 1713–7. doi:10.14219/jada.archive.2004.0124.

Nurmikko, TJ, Eldridge, PR. Trigeminal neuralgia—pathophysiology, diagnosis and current treatment. Br J Anaesth 2001; 87:117.