What is Trigeminal Neuralgia?

Trigeminal neuralgia, a type of neuralgia, is a chronic pain condition affecting the trigeminal nerve, one of the cranial nerves that carries sensation from the face to the brain. In general, neuralgia is pain that travels the path and length of a nerve. With trigeminal neuralgia, the pain usually involves the lower face and jaw, although sometimes it can affect the area around the nose and above the eye.

Pain from trigeminal neuralgia is described as intense, stabbing or like electric shocks. It is typically limited to one side of the face. Even mild stimulation – from touching the face, shaving, brushing teeth or applying makeup – can set off an attack. Episodes may be mild and brief at first but can progress to longer attacks of searing pain.

Baptist Health is known for advanced, superior care in diagnosing and treating trigeminal neuralgia. Our 24/7 inpatient neurology and neurosurgery services as well as our outpatient and Home Health physical, occupational, cognitive and speech therapy services are available to help treat people with trigeminal neuralgia. In addition, we have the region’s only comprehensive cancer center and radiation treatment program, as well as the only advanced 3Tesla MRI, MRI spectroscopy and functional MRI, MRI angiography, CT angiography and conventional cerebral angiography technology to accurately diagnose all manner of neurologic disease, including trigeminal neuralgia.

You will appreciate timely appointments and a professional, friendly atmosphere where we take time to listen to your concerns. At Baptist Health, you have access to the region’s most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost in excellent care to those who trust us with their health.

Trigeminal Neuralgia Signs and Symptoms

Trigeminal neuralgia symptoms may include:

• Episodes of severe, shooting pain that may feel like an electric shock
• Episodes of pain that become more frequent and intense over time
• Pain affecting one side of the face at a time
• Pain focused in one spot or spreading
• Pain in areas supplied by the trigeminal nerve, including the cheek, jaw, teeth, lips, gums and –less often – the eye or forehead
• Pain lasting from a few seconds to several minutes
• Several attacks lasting days, weeks, months or longer
• Spontaneous bursts of pain triggered by things like touching the face, chewing or speaking
• Times of constant aching or burning pain that’s less intense than the shooting pain

Trigeminal Neuralgia Diagnosis

To determine if someone has trigeminal neuralgia, we use advanced diagnostic procedures and technology to effectively diagnose, inform treatment and carefully monitor the condition. Diagnostic procedures can include:

Magnetic resonance imaging (MRI): This test uses a powerful magnet and radio waves to produce images of the head. It can help a physician determine if a blood vessel, multiple sclerosis or a tumor pressing on the trigeminal nerve is causing trigeminal neuralgia.

Neurological examination: Touching and examining parts of the face can help a physician determine where the pain is occurring and which branches of the trigeminal nerve may be affected. Reflex tests can help the physician determine if symptoms are caused by a compressed nerve or another condition.

Trigeminal Neuralgia Causes

Trigeminal neuralgia is often caused by a blood vessel or tumor pressing on the trigeminal nerve, causing it to malfunction.

Risk Factors

Risk factors that may contribute to trigeminal neuralgia include:

Aging: Trigeminal neuralgia is most common in people over the age of 50.

Gender: Women are more likely to develop trigeminal neuralgia than men.

Genetics: Trigeminal neuralgia seems to run in some families.

Multiple sclerosis: This disorder damages the myelin sheath that protects nerves.

Trigeminal Neuralgia Prevention

There is no known way to prevent trigeminal neuralgia.

Trigeminal Neuralgia Prognosis

Without treatment, trigeminal neuralgia often gets progressively worse. However, the pain can nearly always be controlled with medication and/or surgery, and most people will live full and healthy lives.

Trigeminal Neuralgia Treatment and Recovery

Trigeminal neuralgia can be associated with multiple sclerosis, which affect the treatment protocol. Treatment of trigeminal neuralgia seen in patients without multiple sclerosis may include:

Medication

Certain drugs can lessen or block the pain signals sent to the brain. The physician may prescribe:

• Anticonvulsants
• Antispasmodics (muscle relaxers)
• Botox injections

Surgery

Most trigeminal neuralgia surgery is focused on stopping a blood vessel from compressing the trigeminal nerve or blocking pain signals from the trigeminal nerve.

• Stereotactic radiosurgery: This procedure involves a focused dose of radiation delivered to the root of the trigeminal nerve in order to damage it and reduce or eliminate pain. 
• Microvascular decompression: This procedure involves relocating or cushioning blood vessels in contact with the trigeminal nerve root. The surgeon makes an incision behind the ear on the painful side and – through a small hole in the skull – moves vessels in contact with the nerve or places a pad between the vessels and the nerve.

Rhizotomy

In a rhizotomy, the surgeon destroys nerve fibers, which cause some facial numbness. Types of rhizotomy include:

• Balloon compression: In this procedure, the physician inserts a hollow needle through the face and guides it to a part of the trigeminal nerve that goes through the base of the skull. A thin, flexible tube with a balloon on the end is threaded through the needle and the balloon is inflated with enough pressure to damage the trigeminal nerve and block pain signals.
• Glycerol injection: The physician can insert a needle through the face and into an opening in the base of the skull, guiding it into a small sac of spinal fluid that surrounds the trigeminal nerve ganglion. The physician then injects sterile glycerol, which damages the trigeminal nerve and blocks pain signals.
• Radiofrequency thermal lesioning: This procedure selectively destroys nerve fibers associated with pain. While a person is sedated, a surgeon inserts a hollow needle through the face and guides it to a part of the trigeminal nerve that goes through an opening at the base of the skull. Waking the patient from sedation, the surgeon then inserts an electrode through the needle and sends a mild electrical current through the tip of the electrode, asking the patient where he or she feels tingling. When the surgeon locates the part of the nerve associated with pain, he or she re-sedates the patient and heats the electrode to damage those nerve fibers.

Trigeminal Neuralgia Complications

Trigeminal neuralgia treatments can sometimes cause complications, including:

Bleeding or facial bruising: This is usually a temporary complication. 

Limited pain relief: Pain relief from these procedures typically only lasts a few months to years. And, sometimes, the procedures are ineffective at relieving pain.

Numbness: This may occur in part or all of the face.

Problems moving the facial muscles: In rare cases, surgeries or other procedures can affect facial movement.