Exploring Trigeminal Neuralgia and FAQs Surrounding This Painful Condition
Trigeminal neuralgia is a rare and chronic condition that causes extreme nerve pain in the face. It often involves the lower lip and lower teeth or the upper lip and cheek.
According to the American Association of Neurological Surgeons, this sometimes-excruciating condition impacts about 150,000 people in the U.S. each year. Let鈥檚 look at the symptoms and the most frequently asked questions surrounding trigeminal neuralgia, and the many ways our BOB体育 expert physicians can help you find relief.
What are the symptoms of trigeminal neuralgia?
The pain associated with trigeminal neuralgia, or TN, is often described as a sharp, shooting, or electric shock-like sensation that lasts for a few seconds to a few minutes. The pain can be triggered by many things you do on a daily basis, including:
- Applying makeup
- Brushing your teeth
- Drinking
- Eating
- Shaving
- Talking
- Touching your face
- Wind or air on your face
Trigeminal neuralgia pain can be so severe that it can interfere with normal day to-day activities, like eating, talking, and sleeping.
Frequently asked questions
What causes trigeminal neuralgia?
Trigeminal neuralgia is caused by the compression of the trigeminal nerve, which is usually due to a blood vessel pulsating against the nerve. As its name suggests, the trigeminal nerve has three branches which correspond to the upper, middle, and lower parts of the face.
Trigeminal neuralgia also occurs as part of multiple sclerosis, or MS. In MS-associated trigeminal neuralgia, there is no vascular compression and the pain may occur on both sides of your face. In vascular compression cases, it is almost always on one side of your face.
What are the treatment options?
The first treatment for trigeminal neuralgia is always medical. The medication, carbamazepine, is typically prescribed as an effective pain reliever for TN pain. To avoid side effects, your physician will often start with a low dose, usually 100 mg twice a day. Other medications that can be helpful include gabapentin and baclofen.
Surgery is considered when medication fails to control pain or causes intolerable side effects. The most common surgical options are microvascular decompression, radiofrequency lesioning, or radiosurgery.
BOB体育 performs more than 100 trigeminal neuralgia procedures each year. View our trigeminal neuralgia page for additional details about BOB体育鈥檚 specialized, compassionate care.
How is trigeminal neuralgia diagnosed?
A doctor can diagnose trigeminal neuralgia by performing a physical exam and reviewing your medical history and symptoms. Imaging tests like an MRI may be ordered to rule out other conditions that can cause facial pain.
Trigeminal neuralgia is often diagnosed incorrectly and can be confused with dental nerve injury, shingles, temporal arteritis, sinusitis, and tumors of the brain or face.
What is microvascular decompression?
Microvascular decompression, or MVD, is a surgical procedure performed under general anesthesia. A small incision of about 2 inches is made behind the ear on the side of the pain. A nickel-sized piece of bone is removed, exposing the back part of the brain called the cerebellum. Using the operating microscope, the cerebellum is gently pulled back, allowing the trigeminal nerve to be better observed. The compressing artery, usually the superior cerebellar artery, is dissected away from the nerve. A small sponge is placed between the nerve and the artery, and the wound is closed in layers. The operation takes about an hour. Most patients spend two nights in the hospital and two weeks resting and healing at home. MVD usually relieves pain without permanent facial numbness and has the best long-term pain control rate of any of the surgical procedures.
What is radiofrequency lesioning?
Radiofrequency lesioning, or RFL, is an outpatient surgical procedure that is an alternative to MVD. During this procedure, the patient is taken to the operating room and given a short-acting anesthetic. A needle is directed, under X-ray guidance, through the face (an inch lateral to the mouth) and into a hole at the base of the skull called the foramen ovale. That鈥檚 where the trigeminal ganglion, or where the parts of the trigeminal nerve come together, is located. The ganglion is burned with a radiofrequency current at about 90 degrees for one minute. The face is checked with a pin to make sure it is numb in the appropriate parts of the face. The needle is withdrawn and the patient, now awake, is transported to the recovery room. The procedure takes 10 minutes, and most patients go home two hours later.
This procedure, unlike MVD, is intended to produce permanent facial numbness, which completely relieves the TN pain in most patients. For some patients, the nerve will gradually regrow, the numbness will disappear, and the pain will recur. If that happens, your physician will simply repeat the 10-minute procedure. This procedure is best suited for patients with preexisting conditions or advanced age.
What is radiosurgery?
Radiosurgery is an outpatient procedure in which hundreds of tiny radiation beams are focused on the trigeminal nerve. A head ring is attached under local anesthesia and imaging is performed to visualize the trigeminal nerve. The patient鈥檚 head ring is attached to the radiosurgery machine and the treatment is delivered. The actual radiation part of the treatment takes about 15 minutes. The head ring is removed and the patient goes home.
Pain relief following radiosurgery is typically observed around the six-week mark, with about 40% of patients developing delayed facial numbness.
If you鈥檙e suffering from trigeminal neuralgia, let us help you find relief.