Trigeminal Neuralgia
The severe facial pain is caused by contact between an artery or vein and the trigeminal nerve at the base of the brain. This places pressure on the nerve as it enters the brain and causes the nerve to misfire.
Symptoms
Initially short, mild attacks of pain progressing to longer, more frequent bouts of searing pain.
About this Condition
The severe facial pain is caused by contact between an artery or vein and the trigeminal nerve at the base of the brain. This places pressure on the nerve as it enters the brain and causes the nerve to misfire.
After the trigeminal nerve leaves the brain and travels through the skull, it divides into three smaller branches, controlling sensation throughout the face. The first branch controls sensation in the eye, upper eyelid and forehead. The second branch controls sensation in the lower eyelid, cheek, nostril, upper lip and upper gum. The third branch controls sensations in the jaw, lower lip, lower gum and some of the muscles used for chewing.
The painful attacks of trigeminal neuralgia may arise spontaneously, but they may also be provoked by even mild stimulation of the face, such as brushing the teeth, shaving or putting on makeup. The pain of trigeminal neuralgia may occur in a fairly small area of the face, or it may spread rapidly over a wider area. Trigeminal neuralgia usually affects just one side of the face. Rarely, trigeminal neuralgia can affect both sides of the face, but not at the same time. An attack of trigeminal neuralgia can last from a few seconds to about a minute. Some people have mild, occasional twinges of pain, while other people have frequent, severe, electric-shock-like pain. The condition tends to come and go. Remission is less common the longer trigeminal neuralgia persists.
This content is for your general education only. See your doctor for a professional diagnosis and to discuss an appropriate treatment plan.
Conservative Treatments
Medications for Trigeminal Neuralgia
Medications to lessen or block the pain signals sent to your brain are the most common initial treatment for trigeminal neuralgia.
Anticonvulsants: Carbamazepine (Tegretol, Carbatrol), phenytoin (Dilantin, Phenytek) and oxcarbazepine (Trileptal) are the most common anticonvulsant medications used to treat trigeminal neuralgia. Other anticonvulsants include lamotrigine (Lamictal) or gabapentin (Neurontin). If the anticonvulsant you are using begins to lose effectiveness, your doctor may increase the dose or switch to another type. Side effects of anticonvulsants may include dizziness, confusion, drowsiness, double vision and nausea.
Antipasticity Agents: Muscle-relaxing agents such as baclofen (Lioresal, Gablofen) may be used alone or in combination with carbamazepine or phenytoin. Side effects may include confusion, nausea and drowsiness.
Over time, some people with trigeminal neuralgia stop responding to medications, or they experience unpleasant side effects. For those people, injections or surgery provide other treatment options.
Alcohol Injection
Alcohol injections provide temporary pain relief by numbing the affected areas of your face. Your doctor will inject alcohol into the part of your face corresponding to the trigeminal nerve branch causing pain. The pain relief isn't permanent, so you may need repeated injections or a different procedure in the future.
Surgery
Balloon Gangliolysis
In percutaneous balloon gangliolysis of the trigeminal nerve, your doctor inserts a hollow needle through your face and into an opening in the base of your skull. Then, a thin, flexible tube (catheter) with a balloon on the end is threaded through the needle. The balloon is inflated with enough pressure to damage the nerve and block pain signals.
This procedure successfully controls pain in most people, at least for a while. Most people undergoing balloon compression experience some facial numbness, and some may experience temporary or permanent weakness of the muscles used to chew.
Microvascular Decompression
Microvascular decompression involves separating the nerve root and blood vessels with a small Teflon pattie so they are no longer in contact.
During the surgery, your doctor makes an incision behind the ear on the side of your pain to access your facial or trigeminal nerve. Any artery in contact with the nerve root is directed away from the nerve, and the surgeon places a pad between the nerve and the artery.
Decompression can successfully eliminate or reduce symptoms most of the time, but they can recur in some people. While the surgery has a high success rate, it also carries risks. There are small chances of decreased hearing, facial weakness, facial numbness, double vision and even a stroke or death.
Glycerol Injection
During this procedure, called percutaneous glycerol rhizotomy, your doctor inserts a needle through your face and into an opening in the base of your skull. The needle is guided into the trigeminal cistern, a small sac of spinal fluid that surrounds the trigeminal nerve ganglion and part of its root. A small amount of sterile glycerol is injected. After three or four hours, the glycerol damages the trigeminal nerve and blocks pain signals.
The injection relieves pain initially in most people. However, some people have a later recurrence of pain, and many experience facial numbness or tingling.
Electric Current
Percutaneous stereotactic radiofrequency thermal rhizotomy selectively destroys nerve fibers associated with pain.
While you are sedated, your doctor places a hollow needle through your face and into an opening in your skull. Once the needle is positioned, an electrode is threaded through it to the nerve root. You're then awakened from sedation so that you can indicate when and where you feel tingling from the mild current pulsed through the tip of the electrode. When the neurosurgeon locates the part of the nerve involved in your pain, you are returned to sedation. Then the electrode is heated until it damages the nerve fibers, creating an area of injury (lesion). If your pain isn't eliminated, your doctor may create additional lesions.
Almost everyone who undergoes this procedure has some facial numbness after the procedure.
Severing the Nerve
A procedure called partial sensory rhizotomy (PSR) involves cutting part of the trigeminal nerve at the base of your brain. Through an incision behind your ear, your doctor makes a quarter-sized hole in your skull to access the nerve.
Because it cuts the nerve at its source, your face will be numb permanently. In some cases, instead of cutting the nerve the surgeon will choose to traumatize the nerve by rubbing it.
Radiation
Gamma-knife radiosurgery involves delivering a focused, high dose of radiation to the root of the trigeminal nerve. The procedure is painless and typically is done without anesthesia. The radiation damages the trigeminal nerve and reduces or eliminates the pain.
Relief occurs gradually and can take several weeks to begin. This procedure is successful in eliminating pain for the majority of people, but sometimes the pain may recur and the patient may have permanent numbness.
Please keep in mind that all treatments and outcomes are specific to the individual patient. Results may vary. Complications, such as infection, blood loss, and bowel or bladder problems are some of the potential adverse risks of surgery. Please consult your physician for a complete list of indications, warnings, precautions, adverse events, clinical results and other important medical information.