Trigeminal neuralgia (TN) is a chronic, painful condition involving the trigeminal nerve, the nerve responsible for carrying the sensation of pain and other sensations from the face to the brain. The condition causes intense pain in part or all of the face.
The pain can be brought on even by only mild stimulation of the face (such as brushing your teeth or shaving) and is described as feeling like electric shocks or stabbing. People with TN may initially have short, mild instances of pain, but over time experience longer, more frequent attacks of intense pain. Most people with TN experience symptoms in cycles. Pain comes and goes for days or weeks, then subsides. In some cases, the condition becomes progressive and the pain is always present.
There is no specific test for TN, so diagnosis can take time. Treatment depends on the cause and severity of the condition. Several medications are available to provide relief from pain and to decrease the number of episodes. Surgery is sometimes required.
In many cases, the cause of TN is never found. However, known causes include:
- a swollen blood vessel or tumor that puts pressure on the nerve
- multiple sclerosis (MS), a condition that damages the protective coating around nerves (myelin sheath)
- aging—the risk of TN increases after age 50
Although anyone can get TN, it is more common among women than men (NINDS).
The pain of TN can come in sharp spasms that feel like electric shocks. The pain generally occurs on one side of the face and may be brought on by sound or touch. The pain can be triggered by something as routine as:
- brushing your teeth
- putting on makeup
- touching your face
- eating or drinking
- a breeze on your face
You may experience bouts of pain that last only a few seconds or minutes. A series of attacks can last days, weeks, or months, followed by periods of remission.
The condition can progress, with attacks increasing in severity and frequency. In some cases, the pain or ache becomes constant.
There is no single test that can diagnose TN. Diagnosis will depend on the type and location of the pain, and factors that trigger your pain will also be considered. Your doctor will first evaluate your medical history and perform a physical exam before running further tests to rule out other conditions with similar symptoms, such as cluster headaches or post-herpetic neuralgia, a painful condition that affects nerve fibers and skin.
Your doctor will perform a neurological exam that will include touching your face at the location of the pain, which can help your doctor determine which part of the trigeminal nerve is being affected. Your doctor may order magnetic resonance imaging, commonly known as an MRI, to scan your head. This test can help determine whether multiple sclerosis is causing your pain.
Keep a daily journal of symptoms, noting how long they last and what triggers them. Inform your doctor of any home remedies you have tried, and be sure to list any prescription and over-the-counter medications and supplements you take. Also, note any known allergies to medication.
List any diseases and conditions for which you are being treated and any facial injuries and surgeries and procedures that have been performed on your face.
Medication can provide relief from pain and reduce the number of attacks. Some commonly prescribed drugs include:
- muscle relaxants
- anti-seizure medications (drugs that block nerve firing)
- tricyclic antidepressants
While most cases of TN respond to medication, sometimes pain will stop responding to medication and severe symptoms can return. In those cases, surgery may be an option. Common surgical procedures used to treat TN include:
During this outpatient procedure, your doctor will insert a needle through your face and into the base of your skull. The needle is guided to a small sac of spinal fluid that surrounds the root of the trigeminal nerve. Once the needle is in place, a small amount of sterile glycerol is released, damaging the nerve and blocking pain.
This procedure uses computer imaging to deliver highly focused beams of radiation to the root of the nerve. This procedure is painless and is usually performed without anesthesia.
Radiofrequency Thermal Lesioning
This outpatient procedure is performed under general anesthesia, and uses a long, hollow needle to guide an electrical current to the trigeminal nerve. The patient is awakened to assist the doctor in identifying the exact location of the origin of the pain. Once the site of the pain is identified, the electrode is heated and it destroys the nerve.
This procedure uses a targeted approach for delivery of radiation that destroys the trigeminal nerve. It is gaining in popularity because of its precision, effectiveness and the fact that it is considered safer than other surgical treatments.
Other surgical options include severing the nerve or relocating blood vessels that may be putting pressure on the nerve. All surgeries carry the risk of temporary to permanent numbness in the face. In some cases, pain may eventually return.
Your doctor can provide information on the benefits and risks associated with any form of treatment. Upon evaluating your symptoms, medical history, and personal preference, your doctor will help you decide which treatment option is best for you.
If the cause can be identified, proper treatment can correct or manage the condition. For some people, the pain never goes away. TN is not fatal, but in some cases it can be quite debilitating. If the cause cannot be found, the pain can be managed with medication and complementary techniques like acupuncture, nutritional therapy, and meditation. Talk to your doctor before starting any alternative treatments, as these may interact with other medications.