Trigeminal Neuralgia
Trigeminal neuralgia (TN) is characterized by episodes of severe facial pain, usually caused by pressure on the trigeminal nerve near the brainstem. Trigeminal neuralgia can disrupt everyday activities and is considered a type of neuropathic pain. While not life-threatening, it can affect daily life, making it hard to chew, talk, smile, or brush. Patients experience intense pain, which also affects them emotionally.
TN is a long-term condition, but there are treatments to manage symptoms. Data shows that women are more likely to develop TN than men, and most cases are diagnosed after age 50.
The Role of Trigeminal Nerves
The trigeminal nerve is a crucial cranial nerve that connects the brain and brain stem to the face, playing a vital role in how we feel pain, temperature, and touch. Each trigeminal nerve splits into three main branches, which are responsible for sending and receiving sensations from the upper, middle, and lower parts of the face. This nerve is the main pathway for facial sensation, and it helps us detect everything from a gentle touch to sharp pain.
When the trigeminal nerve is irritated, compressed, or damaged—often by a nearby blood vessel or other causes—it can send abnormal pain signals to the brain. This results in the severe facial pain that characterizes trigeminal neuralgia. Because the trigeminal nerve is responsible for such a wide range of facial sensations, any disruption can lead to pain that affects daily life. The connection between the trigeminal nerve and the brain stem is especially important, as it is here that pain signals are processed and interpreted, making this nerve a key player in the experience of trigeminal neuralgia pain.
Trigeminal Neuralgia Symptoms
The most common trigeminal neuralgia symptoms include sudden and extreme pain in the face, often affecting just one side. The pain is often described as stabbing, lancinating, or electrical in sensation, and is considered severe pain. Some patients also experience facial muscle spasms.
Categories of Trigeminal Neuralgia
Other symptoms may persist between attacks, such as numbness, dull ache, burning, and throbbing. Pain attacks in TN typically last only a few seconds but can last up to two minutes and may occur several times a day. Trigeminal neuralgia can be classified into two categories:
Paroxysmal TN
Episodes of sharp and intense pain that last for a few seconds to up to two minutes. There may be breaks between episodes when there is no pain, but the pain may persist for up to 2 hours.
TN with Continuous Pain
This type of TN is categorized as frequent and constant pain with persistent aches. Managing the symptoms of atypical trigeminal neuralgia is more difficult.
Risk Factors and Causes
In most cases, TN only affects one side of the face. Some patients may have pain on both sides of the face, but typically not at the same time. The pain of TN can be triggered by actions such as brushing teeth, eating, or exposure to wind. Simple daily activities can trigger TN episodes, including skincare, shaving, eating, drinking, brushing, flossing, and even smiling. TN pain can be incapacitating and may lead individuals to avoid normal activities due to fear of triggering an attack.
Damage or pressure on the trigeminal nerve causes TN. The most common cause is when the superior cerebellar artery pushes on the trigeminal nerve root. Secondary TN happens when another condition, such as a tumor or multiple sclerosis, damages or affects the nerve. A patient may be diagnosed with Idiopathic TN if doctors find no cause for the facial pain after tests.
Risk factors include:
- Aging
- Smoking
- High blood pressure
- Gender (females are more at risk)
- Family history of TN
Diagnosis and Medical Assessment
Healthcare providers usually start with symptoms and medical history, then proceed to a physical examination. A healthcare provider will conduct a physical examination and review the person’s full medical history when diagnosing trigeminal neuralgia. Pain type, the spot where the pain is most prominent, and triggers are factors that help with diagnosis. A workup for diagnosing trigeminal neuralgia usually includes a neurological examination and imaging with MRI. Physical and neurological examinations may also be done to better understand where the pain is located.
Trigeminal Neuralgia Diagnosis
Many other conditions can cause facial pain, so doctors may often rule out those to diagnose if you have TN. Such conditions include TMJ, migraines, and postherpetic neuralgia. Magnetic resonance imaging (MRI) can help spot the possible causes of TN.
MRI can detect if a tumor or multiple sclerosis is affecting the trigeminal nerve, and newer scanning techniques can show if a blood vessel is pressing on the trigeminal nerve and may even show the degree of compression.
Overall, the diagnosis of trigeminal neuralgia is based on the description of the symptoms provided by the patient, detailed patient history, and clinical evaluation. There are no specific diagnostic tests for trigeminal neuralgia, so physicians must rely heavily on symptoms and history.
Treatment and Pain Relief
Trigeminal neuralgia is treated using medicines, surgery, and other therapies. The right approach depends on the patient’s symptoms. Medication is often the first line of treatment. Anticonvulsant drugs are the primary medications for trigeminal neuralgia, with carbamazepine being the most common medication used to treat trigeminal neuralgia. Gabapentin is also used for pain management. These drugs can help block pain signals, but may have side effects, and their efficacy can decrease over time. A muscle relaxant, such as Baclofen, can also help.
Surgery for trigeminal neuralgia is only recommended when medicines don’t work to manage the pain. Patients diagnosed with secondary trigeminal neuralgia may also benefit from surgery, such as removing a tumor causing pressure on the nerve. Surgical treatment options include several surgical procedures, such as open cranial surgery and lesioning techniques. Surgery options include:
Treatment Options
Microvascular Decompression (MVD)
Regarded as the most long-lasting treatment for trigeminal neuralgia caused by blood vessel compression (vascular compression). MVD is considered the most invasive surgery for TN. It involves placing a sponge or similar device to separate the nerve from the offending blood vessel (surrounding blood vessels), relieving compression of the trigeminal nerve.
Radiosurgery
Stereotactic radiosurgery is a non-invasive treatment option for trigeminal neuralgia that uses focused radiation to relieve pain by targeting the trigeminal nerve root. Radiosurgery does offer relief, but the procedure can take time to show results.
Rhizotomy
These procedures target nerve fibers to relieve nerve pain by damaging the root of the trigeminal nerve, which reduces the pain episodes. Doctors may consider many ways to achieve the goal, such as chemical injections and balloon compression. These procedures may produce numbness or sensory loss as a side effect, but many patients don’t experience pain for at least a few years after successful procedures.
Peripheral Neurectomy
The procedure damages or removes a peripheral branch of the nerve, which can be done through an incision or alcohol injection. Other options include cryotherapy and radiofrequency lesioning.
Additional treatments for trigeminal neuralgia that can be considered with medications include botulinum toxin injections for pain relief, which may be an alternative treatment when oral medications are ineffective, as well as acupuncture, psychotherapy, and yoga.
Trigeminal neuralgia affects different people in unique ways. Some patients have episodes of pain for weeks and then complete relief, while others have constant pain that makes it hard to continue regular activities. Medications used for treating TN may not be as effective over the years, which is also a reason why doctors may consider surgery.
Prognosis and Outlook
The outlook for people with trigeminal neuralgia varies widely, depending on the severity of their symptoms and how well they respond to treatment. With appropriate care, many individuals are able to achieve significant pain relief and regain a better quality of life. However, trigeminal neuralgia is a chronic condition, and pain may persist or return over time.
In some cases, medications may lose effectiveness, and surgical procedures may be needed to relieve nerve compression and provide longer-lasting pain relief. While surgery can offer hope for those with severe or treatment-resistant pain, it is not without risks. Ongoing management and regular follow-up with a healthcare provider are essential to address changes in symptoms and adjust treatment as needed. With a personalized approach, many people with trigeminal neuralgia can find ways to manage their pain and maintain their daily activities.
When to Reach Out
If you are experiencing facial pain that makes it hard even to continue basic activities, you may have trigeminal neuralgia. Patients in Westchester or NYC can connect with us at Chester Neurology for diagnosis and treatment. We have the best experts and advanced testing facilities, ensuring comprehensive care. We have been providing quality care to patients in Westchester, the Bronx, Manhattan, and beyond.
Call us today at (914) 816-1941 or email info@chesterneurology.com to schedule an appointment.
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