Trigeminal Neuralgia

Trigeminal neuralgia is a type of nerve disorder that can cause chronic nerve pain in your face.

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.

The exact cause of trigeminal neuralgia is unknown, however it 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 five percent of patients with multiple sclerosis.

Symptoms

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. Remission can last for weeks, months or years, but attacks usually become more frequent and intense over time. Eventually these attacks may occur daily.

Overview

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.

The exact cause of trigeminal neuralgia is unknown, however it 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 five percent of patients with multiple sclerosis.

Symptoms

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. Remission can last for weeks, months or years, but attacks usually become more frequent and intense over time. Eventually these attacks may occur daily.

It can be difficult to diagnose trigeminal neuralgia. IU Health physicians use physical exam and patient history that describes a characteristic pattern of severe, sudden facial pain to confirm the condition. You may also have magnetic resonance imaging (MRI) or computed tomography (CT) studies.

Diagnosis

It can be difficult to diagnose trigeminal neuralgia. IU Health physicians use physical exam and patient history that describes a characteristic pattern of severe, sudden facial pain to confirm the condition. You may also have magnetic resonance imaging (MRI) or computed tomography (CT) studies.

Treatment of trigeminal neuralgia may include:

Medicine Therapy

Anticonvulsant medicines may lessen or block pain signals sent to the brain. 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 keep the nerve from malfunctioning. Surgical options 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. During this surgery, 3D images of the brain are used 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.

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 a blood vessel is found 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 you are 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.

Treatment

Treatment of trigeminal neuralgia may include:

Medicine Therapy

Anticonvulsant medicines may lessen or block pain signals sent to the brain. 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 keep the nerve from malfunctioning. Surgical options 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. During this surgery, 3D images of the brain are used 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.

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 a blood vessel is found 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 you are 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.