What is trigeminal neuralgia?
The trigeminal nerve carries sensation from the face to the brain. Trigeminal neuralgia (TN), also known as tic douloureux, typically occurs when the nerve becomes compressed by a blood vessel. The pressure results in a jolt of severe pain when any part of the face is stimulated (e.g., brushing teeth, putting on makeup, smiling).
What causes trigeminal neuralgia?
TN is thought to usually be caused by a blood vessel compressing the nerve or related to a disorder that damages the myelin sheath (the protective covering around certain nerves), such as multiple sclerosis. In some cases, TN may also be due to:
- Brain lesion or other abnormality
- Facial trauma
- Surgical injury
- Tumor compressing the trigeminal nerve
What are the symptoms of trigeminal neuralgia?
Symptoms of TN may include:
- Bouts of pain that last from several seconds to several minutes
- Consistent burning, aching feeling that is less sharp than the spasm-like pain
- Moments of shooting pain that may feel like an electric shock
- Pain in areas served by the trigeminal nerve, including the jaw, gums and lips
- Pain that occurs more intensely and frequently over time
- Unprompted bouts of pain triggered by movements such as chewing or speaking
How is trigeminal neuralgia diagnosed?
TN is mainly diagnosed by the description of the pain patients may be experiencing, including the type of pain, where it is located and what triggers it.
Tests to confirm a TN diagnosis include a neurological examination, reflex test or a magnetic resonance imaging (MRI) scan to determine if there is an underlying cause to the condition, such as multiple sclerosis or a tumor.
How is trigeminal neuralgia treated?
TN is usually treated with medication (e.g., anticonvulsants, muscle relaxants, Botox® injections), but those with persistent pain may be candidates for stereotactic radiosurgery or microvascular decompression (MVD) surgery to relieve pressure on the nerve.
Stereotactic radiosurgery is a non-invasive form of radiation therapy in which radiation is focused directly at the root of the nerve in order to damage it. The damage results in a gradual reduction or elimination of pain.
With MVD, the goal is to relocate or remove the blood vessel(s) coming into contact with the nerve. During the procedure, an incision is made behind the ear and in the skull. If it’s an artery that is placing pressure on the nerve, the artery is moved aside and a pad is placed between it and the nerve. If a vein is causing the compression, it may be completely removed.