Trigeminal neuralgia is a form of chronic pain condition that affects a person's trigeminal nerve. The nerve carries sensation from a person's face to their brain. People with this condition find that even mild stimulation of their face, such as from putting on makeup or even brushing their teeth, might trigger a burst of excruciating pain.
Trigeminal neuralgia (TN, or TGN), also known as prosopalgia, or Fothergill's disease is a neuropathic disorder characterized by episodes of intense pain in the face, originating from the trigeminal nerve. It has been described as among the most painful conditions known to humankind.
A person with this condition might experience short and mild attacks, yet trigeminal neuralgia may progress - causing longer and more frequent bouts of searing pain. The condition affects women more often than men and it is more likely to happen in people who are over the age of fifty. Due to the variety of treatments available, having trigeminal neuralgia does not necessarily mean the affected person is doomed to a life filled with pain. Doctors can usually effectively manage trigeminal neuralgia with medications, injections, or surgery. The symptoms of Trigeminal neuralgia can include one or more of the patterns below:
Causes of Trigeminal Neuralgia
With trigeminal neuralgia, the functioning of the affected person's trigeminal nerve is disrupted. Often times, the issue is contact between an average blood vessel and the trigeminal nerve. The contact places pressure on the nerve, causing it to malfunction.
Trigeminal neuralgia may occur as a result of aging, or it might be related to multiple sclerosis or a similar disorder that damages the myelin sheath protecting certain nerves. Less frequently, trigeminal neuralgia may be caused by a tumor compressing the person's trigeminal nerve. Some people might experience trigeminal neuralgia because of a brain lesion or another condition. In other instances, a cause cannot be found. A number of triggers may set off the pain associated with trigeminal neuralgia such as:
Trigeminal Neuralgia Tests and Diagnosis
A doctor will diagnose trigeminal neuralgia. The doctor's diagnosis will mainly be based upon the affected person's description of the pain they experience. Additional factors such as location, type and triggers will help a doctor to achieve a diagnosis.
Type: Pain associated with trigeminal neuralgia is sudden, brief and shock-like.
Location: The parts of a person's face that are affected by pain tell a doctor if the trigeminal nerve is involved.
Triggers: Trigeminal neuralgia-related pain is usually brought on by light stimulation of a person's cheeks such as from talking, eating, or something as simple as a cool breeze.
A doctor may conduct tests to diagnose trigeminal neuralgia and determine underlying causes for the condition. The tests may include the following:
Reflex Tests: A doctor might conduct reflex tests to determine if the person's symptoms are caused by a compressed nerve, or if another condition is causing their symptoms.
A Neurological Examination: Touching and examining parts of an affected person's face may help a doctor to determine exactly where their pain is happening and if the person appears to have trigeminal neuralgia, which branches of the trigeminal nerve may be affected.
Magnetic Resonance Imaging (MRI): A doctor may order and MRI scan of the person's head to determine if multiple sclerosis or a tumor is causing trigeminal neuralgia. At times, a doctor might inject a dye into a blood vessel with the goal of viewing arteries and highlighting blood flow.
The pain people with trigeminal neuralgia experience may be caused by a number of different conditions, so an accurate diagnosis is very important. A doctor may order additional testing in order to rule out other conditions.
Treatments and Medications
Trigeminal neuralgia treatment often begins with medications and a number of people require no additional treatment. Over a period of time; however, some people with the condition might stop responding to medications, or they may experience side-effects which are unpleasant. For these people, injections or surgery can provide other treatment options for trigeminal neuralgia. If the condition is caused by something else such as multiple sclerosis, a doctor will treat the underlying condition.
To treat trigeminal neuralgia, a doctor usually prescribes medications. The medications decrease or block the pain signals sent to the person's brain. These medications include:
Antispasmodic Agents: Muscle-relaxing agents such as baclofen might be administered alone, or in combination with carbamezapine. The side-effects can include nausea, confusion and drowsiness.
Anticonvulsants: Doctors usually prescribe carbamezapine for trigeminal neuralgia. The medication has been shown to be effective in treating the condition. Other anticonvulsant medications that might be used to treat the condition include oxcarbazepine. Other medications that may be used include clonazepam and gabapentin.
If the anticonvulsant a person has been administered starts to lose effectiveness, a doctor might increase the dosage or switch to another type. Side-effects of anticonvulsants may include confusion, dizziness, double vision, drowsiness or nausea. Carbamezapine may trigger a serious drug reaction in some people, so genetic testing might be recommended.
Trigeminal Neuralgia and Surgery
In trigeminal neuralgia surgery, surgeons' goals are to stop the blood vessel from compressing the person's trigeminal nerve, or to damage the trigeminal nerve in order to prevent it from malfunctioning. Damaging the nerve often causes temporary or permanent facial numbness. As with any of the surgical procedures, the pain may return months or even years later. Surgical options for trigeminal neuralgia can include:
Micro-vascular Decompression: The procedure involves relocating or even removing blood vessels that are in contact with the trigeminal root. During the surgery, a doctor makes an incision behind the ear on the side of the person's pain. Through a small hole in the person's skull, a surgeon moves any arteries that are in contact with the trigeminal nerve away from the nerve, placing a pad between the nerve and the person's arteries. If a vein is compressing the nerve, a surgeon might remove it. A doctor may also cut part of the person's trigeminal nerve during the procedure if arteries are not pressing on the nerve. The procedure has some risks associated with it, to include a small chance of decreased hearing, facial numbness, stroke, facial weakness or other complications. The majority of people who have this procedure experience no facial numbness afterward.
Gamma Knife Radiosurgery: In this procedure, a surgeon directs a focused dose of radiation to the root of the person's trigeminal nerve. The procedure uses radiation to damage the person's trigeminal nerve and either reduce or eliminate pain. Relief happens gradually and might take several weeks. Gamma Knife radiosurgery is successful in eliminating pain for most people. If pain recurs, the procedure can be repeated. The fact that Gamma Knife Radiosurgery is effective and safe compared with other surgical options, it is becoming widely used and might be offered instead of other surgical interventions.
Additional procedures might be used to treat trigeminal neuralgia, such as rhizotomy. In rhizotomy, a surgeon destroys the person's nerve fibers, which causes some level of facial numbness. Types of rhizotomy include the following:
Glycerol Injection: During this procedure, a doctor inserts a needle through the person's face and into an opening at the base of their skull. A doctor guides the needle into the trigeminal cistern, a small sac of spinal fluid that surrounds the trigeminal nerve ganglion where the trigeminal nerve divides into three branches and a portion of its root. A doctor injects a small amount of sterile glycerol, which damages the person's trigeminal nerve and blocks pain signals. The procedure often relieves pain, but some people experience a later recurrence of pain and might experience facial tingling or numbness.
Balloon Compression: In balloon compression, a doctor inserts a needle through the person's face and guides it to a part of their trigeminal nerve that goes through the base of their skull. A doctor then threads a thin and flexible tube with a balloon on the end called a, 'catheter,' through the needle. The person's doctor inflates the balloon with enough pressure to damage the trigeminal nerve and block pain signals. The procedure successfully controls pain in most people, for at least some period of time. Most people who undergo the procedure experience some facial numbness. Others experience temporary or permanent weakness of the muscles used to chew.
Radiofrequency Thermal Lesioning: The procedure selectively destroys nerve fibers associated with pain. While the person is sedated, a surgeon inserts a needle through their face and guides it to a part of the trigeminal nerve that goes through an opening at the base of the person's skull. After the needle is positioned, the surgeon wakes the person from sedation and inserts an electrode through the needle and sends a mild electrical current through the tip of the electrode. The person is asked to indicate when and where they experience a tingling sensation. When the person's neurosurgeon locates the part of the nerve involving pain, the person is returned to sedation. The electrode is heated until it damages the nerve fibers, creating a lesion. If the person's pain is not eliminated, the doctor might create additional lesions. Radiofrequency thermal lesioning usually results in some temporary facial numbness following the procedure.
Living with trigeminal neuralgia may be hard. The disorder might affect your interaction with family members and friends. It may also affect productivity at work and the person's overall quality of life. Support groups can help those affected to find understanding and encouragement. Members of the group many times know about the latest treatments and tend to share their own personal experiences. A doctor might be able to recommend a group in the person's area.
NINDS Trigeminal Neuralgia Information Page