Trigeminal neuralgia (TN) — also known as tic douloureux — is a type of nerve pain that affects the face, typically the jaw or cheek. TN is a rare condition that affects the trigeminal nerve, which controls sensation and feeling in your face. Although the condition is not life-threatening, it can cause debilitating pain that can be so severe that you have difficulty talking, eating, or drinking.
UPMC is a pioneer in treating trigeminal neuralgia. Some of the most effective treatments, such as microvascular decompression, were developed and implemented at the University of Pittsburgh.
UPMC's neurosurgeons have the expertise required to diagnose and treat TN, helping you take the first steps toward reducing the severity of your symptoms and improving your quality of life.
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What Is Trigeminal Neuralgia?
Trigeminal neuralgia (TN) — also known as tic douloureux — is a type of nerve pain that affects the face, typically the jaw or cheek. TN is a rare condition that affects the trigeminal nerve, which controls sensation and feeling in your face. Although the condition is not life-threatening, it can cause debilitating pain that can be so severe that you have difficulty talking, eating, or drinking.
What are the types of trigeminal neuralgia?
There are two types of trigeminal neuralgia based on the symptoms you experience.
Types include:
- Paroxysmal TN (type 1) — Causes sporadic episodes of sharp, intense pain that last from a few seconds to two minutes.
- Atypical TN (type 2) — Causes dull, burning, and continuous pain that is less intense than type 1.
How common is TN?
According to the American Association of Neurological Surgeons, 150,000 people per year are diagnosed with TN. It is most common in people over age 50 and is twice as common in women than in men.
What causes TN?
The most common cause of trigeminal neuralgia is a blood vessel pressing against your trigeminal nerve. Rare causes include multiple sclerosis or tumors.
TN risk factors
You may be at increased risk of TN if you:
- Are female.
- Are over age 50.
- Have a family history of TN.
- Have high blood pressure.
- Have multiple sclerosis.
- Smoke.
Complications of TN
Complications of TN may include:
- Loss of feeling in your face after treatment.
- Medication side effects.
- Mental health problems, such as depression and anxiety.
- Social isolation from avoiding pain triggered by talking.
- Weight loss from avoiding pain triggered by eating.
How can I prevent TN?
Unfortunately, there is no way to prevent trigeminal neuralgia. If certain activities trigger your pain, you should avoid them when possible.
What Are the Signs and Symptoms of TN?
The main symptom of TN is severe pain, which usually occurs anywhere from the forehead to the jaw, typically in front of your ear. The trigeminal nerve has three branches: one controlling sensation in your eye, another controlling sensation in your cheek, and a third controlling sensation in your jaw. TN pain usually involves one or two of these branches. It can occasionally affect all three.
Symptoms of TN may include:
- Absence of pain between flare-ups.
- Anxiety from the thought of the pain returning.
- Attacks that get more intense and frequent over time.
- Pain in your cheek or jaw — typically comes and goes and is mostly on one side of your face.
- Pain that feels like electric shocks or stabbing.
- Pain triggered by touching, eating, brushing your teeth, or other factors, like wind.
When should I see a doctor about my TN symptoms?
Although this condition is not fatal, it can disrupt your life. Talk to your primary care provider about your trigeminal neuralgia pain. Your provider can determine the best pain management method for you.
How Do You Diagnose TN?
Your doctor will diagnose TN with a physical exam.
This diagnosis is based on three different factors:
- Location of pain — The pain is mostly in your jaw or cheek.
- Triggers of pain — Pain usually occurs when your cheeks are stimulated by eating, talking, or brushing your teeth.
- Type of pain — Pain related to trigeminal neuralgia is sudden, shock-like, and brief.
Your doctor will also ask about your history and symptoms and perform other tests.
What to expect during your visit
The first step in evaluating your facial pain is determining whether you have trigeminal neuralgia or some other form of facial pain. Proper diagnosis is crucial to helping your doctor recommend the best treatment for your condition.
Your doctor will ask a variety of questions to determine whether you have typical trigeminal neuralgia or another type of facial pain. They will also ask questions about prior dental work, difficulty chewing, and current or prior diseases.
Your doctor also may order an MRI scan to rule out other health issues, such as:
- A tumor.
- Arteriovenous malformation.
- Dental pain.
- Headaches or migraine.
- Lyme disease.
- Multiple sclerosis.
- Shingles.
Tests to diagnose TN
You will need an MRI scan to diagnose TN and rule out other causes of facial pain.
After you receive a TN diagnosis, an MRI is performed for two reasons:
- To determine if a lesion, such as a tumor or a tangle of blood vessels (arteriovenous malformation), is causing TN symptoms.
- To determine if there is a blood vessel pushing on your nerve.
TN prognosis
Your prognosis after a TN diagnosis depends on the underlying cause of your condition, your overall health, and other factors. With treatment, TN symptoms may improve.
What is the life expectancy of someone with trigeminal neuralgia?
People with trigeminal neuralgia typically have a normal life expectancy. Although trigeminal neuralgia doesn’t shorten your life span, it can cause intense pain and distress that increases your risk for anxiety, depression, and suicide if left untreated.
How Do You Treat TN?
Your doctor will develop a personalized treatment plan for TN, with the goal of reducing symptom severity and improving your quality of life.
Treatment options may include:
Medications for TN
TN treatment typically starts with medications that can help treat your nerve pain.
Your doctor may prescribe medications including:
- Anticonvulsants — Typically the first drugs your doctor will try, these medications help block your nerve from sending pain signals.
- Antidepressants — May help treat pain and other symptoms.
Medication doesn't work for everyone. Certain medications may cause side effects, and pain can continue for some people even when taking the drugs. If medications do not work and your pain persists, surgery may be an option.
Surgery for TN
In the last 25 years, UPMC neurosurgeons have treated more than 20,000 people with TN.
Surgical options for trigeminal neuralgia include procedures that:
- Relocate or remove blood vessels that are in contact with the trigeminal nerve root to stop the nerve from malfunctioning.
- Use radiation to damage the trigeminal nerve and reduce or eliminate pain.
- Use minimally invasive injections to damage the trigeminal nerve and block pain signals.
- Selectively destroy the nerve fibers associated with pain.
Surgical procedures include:
Microvascular decompression (MVD)
MVD is a minimally invasive surgery that stops your blood vessel from putting pressure on your nerve. MVD works well for trigeminal neuralgia but is not as effective for atypical trigeminal neuralgia.
During the procedure, your surgeon will insert surgical instruments at the end of a flexible tube through a small incision. For most people with TN, MVD:
- Treats the cause of the problem.
- Offers the most long-lasting relief.
- Has a lower risk of side effects after surgery.
During the procedure, your UPMC surgeon will:
- Make an incision behind your ear.
- Make a hole in your skull the size of a silver dollar.
- Use a thin, lighted camera tube with special tools to find the blood vessel that is putting pressure on your nerve.
- Pull the blood vessel away from your nerve and put a “pillow" in between to keep them from touching.
What is the success rate for MVD?
MVD provides fast, complete relief of TN symptoms in 82% of people. Another 16% of people who have MVD experience partial relief and may need to continue to take occasional or low-dose medication.
One year after their MVD procedure, 75% of people continue to have complete pain relief and 8% have partial relief. Fewer than 5% of people have major side effects after MVD surgery.
Gamma Knife stereotactic radiosurgery for TN
Gamma Knife stereotactic radiosurgery is a painless, incisionless treatment that uses hundreds of highly focused radiation beams to damage your nerve and prevent transmission of pain signals.
Your surgeon may recommend Gamma Knife if you:
- Are at higher risk of side effects from other treatments.
- Are older.
- Have other health issues and are not a candidate for neurosurgery.
- Have pain that continues even after neurosurgery.
UPMC is the nation's leading provider of Gamma Knife procedures.
In 25 years, UPMC surgeons have used Gamma Knife to help nearly 12,000 people with:
- Brain tumors.
- Blood vessel malformations.
- Pain and other problems.
Why Choose UPMC for TN Care?
When you choose UPMC for TN care, you will receive:
- Expert care from an experienced team of providers — UPMC is a high-volume center for diagnosing and treating people with TN. Each year, we provide care for over 500 people with TN, with approximately 100 undergoing surgery to treat the condition.
- Access to advanced clinical trials — UPMC participates in research to improve TN treatment options.
- World-class TN treatment — UPMC is a world leader in caring for people with trigeminal and atypical trigeminal neuralgia.
