Trigeminal Neuralgia

What is trigeminal neuralgia?

Trigeminal (try-GEM-in-ol) neuralgia (noor-AL-ja) is a nerve disorder. With this disorder, you get sudden bursts of very intense pain on one side of your face. It is felt in the area of your lips, gums, cheek, or chin. The pain lasts only a few seconds or minutes, but it’s so intense that you may wince. Some people described the pain as lightening bolts, knife thrusts, or electric shocks.

Another name for the disorder is tic (TICK) douloureux (doo-luh-ROO), which means “painful twitch.” Most people who develop the disorder are over age 50, but younger people can have it too. This disorder affects more women than men.

What triggers the pain?

Triggers affect some people who have trigeminal neuralgia. A trigger is anything that can start or set off the pain. For example, lightly touching your mouth or face, talking, eating, drinking cold drinks, brushing your teeth, or wind on your face may trigger pain. Some people with trigeminal pain do not seem to be affected by triggers.

What are the types of trigeminal pain?

There are 3 types of trigeminal pain: typical, atypical, and transitional.

Typical

  • The pain is sharp, like an ice pick or a shock.
  • The pain comes and goes for short or long periods of time.
  • The pain disappears for short or long periods of time.
  • The pain has triggers that you can identify.

Atypical

  • The pain can be burning, aching, or throbbing, as well as sharp or stabbing.
  • The pain may or may not disappear for periods of time.
  • The pain has no known triggers.

Transitional

The pain is both typical and atypical.

What causes the nerve disorder?

The medical name for nerve pain is “neuralgia.” Trigeminal neuralgia affects a large nerve in the face called the trigeminal nerve. The nerve becomes irritated, causing pain. For example, an artery or a vein may be pressing against the nerve. The blood vessel may rub against the nerve each time the heart beats. The repeated contact can start to wear down the nerve’s protective covering. This can lead to periods of severe pain.

How is this disorder detected?

Your doctor will ask about your symptoms and your overall health. You will have a physical exam and a nerve exam. You also may have MRI (magnetic resonance imaging) of your head to check for possible causes of your face pain. The exams and test may rule out other possible causes of your pain. If so, your doctor may diagnose the pain as trigeminal neuralgia, based on the symptoms.

How is the disorder treated?

 

Medicine

 
The first treatment usually prescribed is medicine. The drugs most often used are anti-convulsants. These drugs help to reduce trigeminal nerve impulses and so relieve pain. Examples are carbamazepine (brand name Tegretol), phenytoin (Dilantin), oxcarbazepine (Trileptal), and gabapentin (Neurontin). Over time, the pain may become more severe. So the drug or its dosage may need to be changed.
 

Surgery

 
Surgery may be necessary if treatment with drugs is not effective.
 
Microvascular decompression
 
An operation called microvascular (my-crow-VAS-kyoo-ler) decompression removes the pressure that is against the nerve . During the operation, the surgeon makes an incision behind the ear to reach the trigeminal nerve. A small pad is then placed between the trigeminal nerve and the blood vessel pressing on it. The pad stops the blood vessel from irritating the nerve. This procedure usually gives long-term pain relief. If pain continues, low-dose anti-convulsants can help control pain. Sometimes repeating the procedure gives relief.
 
Other surgical procedures
 
Another way to reduce pain is to damage the trigeminal nerve. The result is numbness in the area where the pain was felt. Sometimes the numbness is permanent. Surgical procedures used include:
  • Glycerol injections — Shots are given under the facial skin to numb the area.
  • Gamma Knife surgery — A focused, high dose of radiation is delivered to the trigeminal root.
  • Electrocoagulation (ee-LEK-tro-ko-ag-you-LAY-shun) — An electric current is passed through an electrode to nerve fibers.
  • Balloon compression — A tiny balloon at the end of a very fine tube is inserted and then inflated against the nerve.

These procedures may relieve the pain for years. They are an option for people with MS (multiple sclerosis) or other health problems that rule out microvascular decompression.

For More Information

Other helpful resources include:

Trigeminal Neuralgia Association
2801 S.W. Archer Road, Suite C
Gainesville, FL 32608
Phone: 352-376-9955
Fax: 352-376-8688
E-mail: tnanational@tna-support.org
Web: http://www.tna-support.org

American Chronic Pain Association (ACPA)
P.O. Box 850Rocklin, CA 95677-0850
Phone: 1-800-533-3231
Fax: 919-632-3208
E-mail: ACPA@pacbell.net
Web: http://www.theacpa.org

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