Trigeminal Neuralgia: Causes, Symptoms & Diagnosis
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Trigeminal Neuralgia

What Is Trigeminal Neuralgia?

Trigeminal neuralgia (TN) is a painful, chronic condition involving the trigeminal nerve. There are about 12 cases per 100,000 people in the United States each year.

There are two separate trigeminal nerves, one on each side of the face. These nerves are responsible for carrying the sensation of pain and other sensations from the face to the brain. Each nerve has three branches (forehand, midface, and chin). It’s possible to have TN of any (or all) branches. TN causes intense pain in part or all of the face.

The pain can be brought on by mild stimulation of the face, such as brushing your teeth or shaving. It’s often described as feeling like electric shocks or stabbing. People with TN may initially have short, mild instances of pain, but over time they may 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 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. Sometimes surgery is required.

Symptoms of Trigeminal Neuralgia

Symptoms

The pain of TN can come in sharp spasms that feel like electric shocks. Pain generally occurs on one side of the face and may be brought on by sound or touch. Pain can be triggered by routine acts, including:

  • brushing your teeth
  • shaving
  • putting on makeup
  • touching your face
  • eating or drinking
  • speaking
  • 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.

Causes of Trigeminal Neuralgia

Causes

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, a condition that damages the myelin sheath, which is the protective coating around nerves

According to the National Institute of Neurological Disorders and Stroke, although anyone can get TN, it’s more common among women than men. It’s also more common in people over the age of 50, although it can occur at any age.

How Trigeminal Neuralgia Is Diagnosed

Diagnosis

There’s no single test that your doctor can order to help them diagnose TN. Diagnosis will depend on the type and location of the pain and factors that trigger the pain. Your doctor will first evaluate your medical history and perform a physical exam. This will include a neurological exam to determine which part of the trigeminal nerve is being affected. They will touch various parts of your face to determine the location of the pain.

Then they will order tests to rule out other conditions with similar symptoms, such as cluster headaches or postherpetic neuralgia, which is a painful condition that affects nerve fibers and skin. They may also order an MRI of your head, which can help determine whether multiple sclerosis is causing your pain.

Treating Trigeminal Neuralgia

Treatment

Medication

Medication can provide relief from pain and reduce the number of attacks. The first form of treatment is typically anti-seizure medications, which are drugs that block nerve firing. Some other second line or adjunctive medications include muscle relaxants and tricyclic antidepressants.

Surgery

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:

Glycerol Injections

During this procedure, you will be heavily sedated and receive local anesthesia. Your doctor will insert a needle through your cheek and into the base of your skull. The needle is guided by X-ray 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. The glycerol may block the nerve’s ability to transmit signals related to pain or it may enable the insulation of the damaged nerve to heal. It should not damage the nerve. The procedure typically takes only a few minutes to complete and you can go home the same day.

Stereotactic Radiosurgery

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. You will be awake during the procedure to assist your 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.

Gamma-Knife Radiosurgery

This is an outpatient procedure that uses a targeted approach for delivery of radiation that destroys the trigeminal nerve. It’s growing in popularity because of its precision, effectiveness, and the fact that it’s considered safer than other surgical treatments and is the least invasive option.

Microvascular Decompression

This is a major medical procedure that involves brain surgery. The procedure works by relieving pressure from the affected nerves and allowing them to heal. Studies have shown 90 percent of patients report pain relief.  

Other Options

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.

How to Prepare for Your Appointment

home treatment

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.

Also, list any diseases you’re being treated for and any facial injuries, surgeries, or procedures that have been performed on your face.

Living with Trigeminal Neuralgia

Outlook

Proper treatment is essential to treating TN. Discussing the treatment options with your doctor will help you decide on the most appropriate option. Complementary techniques like acupuncture, nutritional therapy, and meditation may also help with some of your symptoms. Talk to your doctor before starting any alternative treatments, as these may interact with other medications.

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