What is trigeminal neuralgia?

Trigeminal neuralgia (TN), also known as tic douloureux, is a condition in which the trigeminal nerve becomes compressed, usually by a blood vessel. The pressure on this nerve—which carries sensation from the face to the brain—results in a shock of intense pain when the face is stimulated (e.g., smiling, brushing teeth, eating or drinking). The pain can last from several seconds to several minutes. 

What causes TN?

In addition to pressure from a blood vessel, TN may also be due to:

• A brain lesion or other deformity
• Compression of the nerve by a tumor
• Disorders that damage the myelin sheath, the protective coating around certain nerves (e.g., multiple sclerosis)
• Facial trauma
• Injury from surgery
• Stroke

What are are the symptoms of trigeminal neuralgia?

In addition to the bouts of severe pain upon face stimulation, symptoms can include: 

• A frequent burning, aching feeling (that is less sharp than the spasm-like pain)
• Incidents of pain that may feel like an electric jolt
• Pain in the jaw, gums and lips
• Pain that appears more powerfully and frequently over time 

How is it diagnosed?

Diagnosis is mainly based on the patient’s description of pain, including type, location and triggers.

Sometimes, tests may also be performed to confirm a TN diagnosis. These include a thorough neurological examination, a magnetic resonance imaging (MRI) scan (to see if there’s an underlying cause, such as a tumor) or a reflex test.

How is TN treated?

TN is usually managed with medication—such as anticonvulsants, muscle relaxants (antispasmodic) or Botox injections—to reduce or block the pain signals to the brain. In some cases, however, medication can become less effective over time or cause unpleasant side effects.

Should medication fail, surgery may become the next viable option to relieve pain and other symptoms of TN. Surgical procedures include:

Microvascular Decompression (MVD)

The goal of MVD is to relocate or remove the blood vessel(s) pressing on the nerve. During an MVD, the physician makes a small incision behind the ear, then moves the arteries away from the nerve and places a pad between the two. If a vein is causing the compression, it may simply be removed during the procedure.

Stereotactic Radiosurgery

Stereotactic radiosurgery is a noninvasive therapy that allows the physician to target a specific spot with radiation. In the case of TN, it is aimed at the root of the nerve in order to damage it, resulting in the elimination or gradual reduction of pain.

Rhizotomy

During a rhizotomy, a surgeon destroys the nerve fibers in the face, resulting in some numbness. Types of rhizotomy include:

• A glycerol injection that is guided into the trigeminal cistern—a small sac filled with spinal fluid where the nerve divides—to damage it
• Balloon compression to place pressure on the nerve to damage it
• Radiofrequency thermal lesioning that uses a heated electrode threaded through a catheter to injure the part of the nerve causing symptoms

For more information about trigeminal neuralgia or to schedule an appointment with a specialist, contact us today.