What Is Trigeminal
Trigeminal neuralgia (TN) is a painful, chronic
condition involving the trigeminal nerve. There are about 12 cases per 100,000 people in the United States each year.
two separate trigeminal nerves, one on each side of the face. These nerves are
responsible for carrying the sensation of pain and other sensations from the
face to the brain. Each nerve has three branches (forehand, midface, and chin).
It’s possible to have TN of any (or all) branches. TN causes intense pain in
part or all of the face.
The pain can
be brought on by mild stimulation of the face, such as brushing your teeth or
shaving. It’s often described as feeling like electric shocks or stabbing.
People with TN may initially have short, mild instances of pain, but over time they
may experience longer, more frequent attacks of intense pain. Most people with
TN experience symptoms in cycles — pain comes and goes for days or weeks, then
subsides. In some cases, the condition becomes progressive and pain is always
There is no
specific test for TN, so diagnosis can take time. Treatment depends on the
cause and severity of the condition. Several medications are available to
provide relief from pain and to decrease the number of episodes. Sometimes surgery
Symptoms of Trigeminal
The pain of
TN can come in sharp spasms that feel like electric shocks. Pain generally
occurs on one side of the face and may be brought on by sound or touch. Pain
can be triggered by routine acts, including:
breeze on your face
experience bouts of pain that last only a few seconds or minutes. A series of
attacks can last days, weeks, or months, followed by periods of remission.
condition can progress, with attacks increasing in severity and frequency. In
some cases, the pain or ache becomes constant.
Causes of Trigeminal
cases, the cause of TN is never found. However, known causes include:
swollen blood vessel or tumor that puts pressure on the nerve
sclerosis, a condition that damages the myelin sheath, which is the protective
coating around nerves
Institute of Neurological Disorders and Stroke, although anyone can get TN, it’s
more common among women than men. It’s also more common in people over the age
of 50, although it can occur at any age.
How Trigeminal Neuralgia Is
There’s no single
test that your doctor can order to help them diagnose TN. Diagnosis will depend
on the type and location of the pain and factors that trigger the pain. Your
doctor will first evaluate your medical history and perform a physical exam. This will include a neurological exam to determine which part of
the trigeminal nerve is being affected. They will touch various parts of your
face to determine the location of the pain.
Then they will
order tests to rule out other conditions with similar symptoms, such as cluster headaches or postherpetic neuralgia, which is a painful condition that
affects nerve fibers and skin. They may
also order an MRI of your head, which can help determine whether multiple
sclerosis is causing your pain.
can provide relief from pain and reduce the number of attacks. The first form
of treatment is typically anti-seizure medications, which are drugs that block
nerve firing. Some other second line or adjunctive medications include muscle
relaxants and tricyclic antidepressants.
While most cases
of TN respond to medication, sometimes pain will stop responding to medication
and severe symptoms can return. In those cases, surgery may be an option.
Common surgical procedures used to treat TN include:
procedure, you will be heavily sedated and receive local anesthesia. Your
doctor will insert a needle through your cheek and into the base of your skull.
The needle is guided by X-ray to a small sac of spinal fluid that surrounds the
root of the trigeminal nerve. Once the needle is in place, a small amount of
sterile glycerol is released. The glycerol may block the nerve’s ability
to transmit signals related to pain or it may enable the insulation of the
damaged nerve to heal. It should not damage the nerve. The procedure typically takes only a few minutes
to complete and you can go home the same day.
uses computer imaging to deliver highly focused beams of radiation to the root
of the nerve. This procedure is painless and is usually performed without anesthesia.
Radiofrequency Thermal Lesioning
procedure is performed under general anesthesia and uses a long, hollow needle
to guide an electrical current to the trigeminal nerve. You will be awake
during the procedure to assist your doctor in identifying the exact location of
the origin of the pain. Once the site of the pain is identified, the electrode
is heated and it destroys the nerve.
This is an
outpatient procedure that uses a targeted approach for delivery of radiation
that destroys the trigeminal nerve. It’s growing in popularity because of its
precision, effectiveness, and the fact that it’s considered safer than other
surgical treatments and is the least invasive option.
This is a major
medical procedure that involves brain surgery. The procedure works by relieving
pressure from the affected nerves and allowing them to heal. Studies have shown
90 percent of patients report pain relief.
surgical options include severing the nerve or relocating blood vessels that
may be putting pressure on the nerve. All surgeries carry the risk of temporary
to permanent numbness in the face. In some cases, pain may eventually return.
can provide information on the benefits and risks associated with any form of
treatment. Upon evaluating your symptoms, medical history, and personal
preference, your doctor will help you decide which treatment option is best for
How to Prepare for Your
Keep a daily
journal of symptoms, noting how long they last and what triggers them. Inform
your doctor of any home remedies you have tried, and be sure to list any
prescription and over-the-counter medications and supplements you take. Also,
note any known allergies to medication.
any diseases you’re being treated for and any facial injuries, surgeries, or procedures
that have been performed on your face.
Living with Trigeminal
treatment is essential to treating TN. Discussing the treatment options with
your doctor will help you decide on the most appropriate option. Complementary
techniques like acupuncture, nutritional therapy, and meditation may also help
with some of your symptoms. Talk to your doctor before starting any alternative
treatments, as these may interact with other medications.