Trigeminal Neuralgia

At the Indiana University Health Neuroscience Center, our experts provide comprehensive evaluation and sophisticated treatment of trigeminal neuralgia, a type of nerve pain that affects your face. Trigeminal neuralgia is a chronic nerve disorder that can cause significant pain. The trigeminal nerve carries sensation from your face to your brain. If this nerve becomes compressed by an artery at the brainstem level, it can produce stabbing or electric, shock-like pain. Though the cause is unknown, trigeminal neuralgia is more likely to affect people older than 50 and those who have other health problems. It is more common in women than men and is seen in up to 5 percent of patients with multiple sclerosis.

The key symptom of trigeminal neuralgia is sudden shooting or stabbing pain along one side of the face. People describe this pain as feeling like an electric shock or lightning bolt that can last up to several seconds. Certain everyday activities, such as brushing your hair or teeth, putting on makeup, chewing food or simply touching your face, can bring on painful episodes. Trigeminal neuralgia pain can come and go, and there may be long periods of remission with no pain. Remissions can last for weeks, months or years, but attacks usually become more frequent and intense over time. Eventually these attacks may occur daily.

Our doctors are experts at diagnosing trigeminal neuralgia. To confirm the condition, they rely on a physical exam and patient history that describes a characteristic pattern of severe, sudden facial pain. Doctors may also conduct magnetic resonance imaging (MRI) or computed tomography (CT) studies.

There are several ways to treat trigeminal neuralgia, ranging from medicine to a variety of surgical options. The IU Health Neuroscience Center offers a full range of the most innovative treatments, along with highly skilled doctors who create personalized treatment plans.

Medicine

Your doctor may prescribe anticonvulsant medicines to treat trigeminal neuralgia. These medicines lessen or block pain signals sent to the brain and are the most common initial treatment. Over time, however, you may experience breakthrough pain. Additionally, higher doses can cause side effects that affect memory and balance, which can be a problem, especially for older people. If medicine is not sufficient, you may need to explore surgical options.

Surgery

The goal of any surgery for trigeminal neuralgia is either to stop the blood vessel from compressing the trigeminal nerve or to damage the nerve to keep it from malfunctioning. The surgeries performed at IU Health include:

  • Stereotactic radiosurgery. Stereotactic radiosurgery, or Gamma Knife surgery, is a noninvasive treatment that uses targeted radiation to cause mild damage to the trigeminal nerve, which reduces pain signals sent to the brain. Our radiation oncologists and neurosurgeons use 3D images of the brain to deliver very high doses of radiation directly to the area where the nerve is compressed. Because the treatment is so precise, there is little exposure to surrounding healthy tissue. Gamma Knife surgery is the latest surgical treatment for trigeminal neuralgia. The procedure is painless, typically done without anesthesia, and has very few complications. However, it can take four to six weeks to be effective. It is especially appropriate for older people who have other health problems.
  • Microvascular decompression. Microvascular decompression (MVD) gets at the root cause of trigeminal neuralgia and is most likely to stop the pain with no nerve injury. During the operation, which requires general anesthesia, a very small opening is made in the skull just behind the ear. Neurosurgeons locate the nerve where it leaves the brainstem. If they find a blood vessel pressing on the trigeminal nerve, a soft piece of shredded Teflon is placed between the vessel and the nerve, lifting it away from the nerve and alleviating pain by eliminating compression. MVD is often recommended for younger patients who have few health problems and can tolerate general anesthesia.
  • Balloon compression. Balloon compression is performed while the person is under general anesthesia. This technique allows a neurosurgeon to insert a hollow needle through an opening in the base of the skull. A thin catheter with a balloon on the end is threaded through the needle. The balloon is then inflated with enough pressure to damage the nerve and block pain signals.

Percutaneous Needle Procedure

In this method, a needle is inserted into the skin beside the mouth and moved towards the trigeminal nerve. Once the location is confirmed, the needle tip heats to a carefully controlled high temperature and damages the nerve. The procedure can be done in an outpatient setting, often causing immediate relief. However, sometimes the pain returns. The percutaneous approach is best suited for older patients with medically unresponsive trigeminal neuralgia.