Trigeminal Neuralgia

Overview

Trigeminal neuralgia is a severe form of facial pain.  Trigeminal neuralgia develops in mid to late life.  The condition is the most frequently occurring of all the nerve pain disorders.  The pain, which comes and goes, feels like bursts of sharp, stabbing, electric-shocks.  This pain can last from a few seconds to a few minutes.  People often call trigeminal neuralgia "tic douloureux" because of a characteristic muscle spasm (facial twitching) that accompanies the pain.

People with trigeminal neuralgia become plagued by intermittent severe pain that interferes with common daily activities such as eating and sleep.  They live in fear of unpredictable painful attacks, which leads to sleep deprivation and poor nutrition.  The condition can lead to irritability, severe anticipatory anxiety and depression, and life-threatening malnutrition.

The pain comes from one or more branches of the trigeminal nerve, a nerve at the base of the brain—the major carrier of sensory information from the face to the brain.  In almost all cases (97%), pain will be restricted to one side of your face. 

Most of the time, doctors cannot identify any disease of the trigeminal nerve or the central nervous system.  The condition has no clear-cut cause.  A defining feature of trigeminal neuralgia is the trigger zone—a small area in the central part of the face, usually on a cheek, nose, or lip, that, when stimulated, triggers a typical burst of pain.

It is essential you see a doctor familiar with the care of patients with trigeminal neuralgia early on to help prevent the development of more severe complications.  It is especially important to work with your doctor because with appropriate drug therapy trigeminal neuralgia can almost always be controlled. 

Trigeminal neuralgia most frequently affects women older than 50 years.  The disease occurs rarely in those younger than 30 years.  Such cases are usually linked to damage from diseases of central nervous system, for example, multiple sclerosis.

Medications

Common medications to treat trigeminal neuralgia are Lioresal, Tegretol, Lamictal, Neurontin, Dilantin, Trileptol and Klonazepin.

Surgery

Surgey is reserved for those patients that continue to have severe pain in spite of medical management.  The surgical options for trigeminal neuralgia include peripheral nerve blocks or ablation, gasserian ganglion and retrogasserian ablative (needle) procedures, craniotomy followed by microvascular decompression (MVD), and stereotactic radiosurgery (Gamma Knife®).

If doctors clearly determine the cause of the disorder to be compression of an artery on the trigeminal nerve deep in your skull, a neurosurgeon can perform a microvascular decompression.  The surgeon moves the compressing artery to a location away from the compressed root of the nerve. 

No treatment for Trigeminal Neuralgia is guaranteed to give permanent relief.  Each patient responds to treatment differently.  For most, medication alone is adequate.  For those that have relentless pain, in spite of an adequate medical trial, surgery may be necessary to augment the use of the medication.

For more information about Trigeminal Neuralgia please visit the National Institutes of Health.  On the left hand side of their web page click Trigeminal Neuralgia.

Additional information is available from The American Association of Neurological Surgeons pamphlet:  What You Should Know About Trigeminal Neuralgia.