This page is intended as a patient/relative information source only. It is not a substitute for professional medical advice.
What Is Trigeminal Neuralgia?
Neuralgia means nerve pain. Trigeminal refers to the trigeminal nerve. Hence, trigeminal neuralgia means pain coming from the trigeminal nerve.
The trigeminal nerve is one of the largest nerves in the head. There are two of these nerves (one on either side of the face) which are responsible for providing the sensations of touch and pain as well as controlling the muscles needed for chewing food. The trigeminal nerve splits into 3 branches in the face. One goes to your scalp and forehead, one to your cheek and one to your jaw. Any one or more of these branches can be affected by trigeminal neuralgia.
What Are The Symptoms Of Trigeminal Neuralgia?
Patients with trigeminal neuralgia may experience severe pain which starts suddenly and usually affects the cheek and/or jaw on one side of the face. It is not uncommon for the pain to feel like it is coming from your mouth or teeth so people sometimes mistakenly go to their dentist before a diagnosis is made.
The pain caused by trigeminal neuralgia sometimes described as ‘the worst pain known to man’ and is described differently by different people. Previous patients have said that it is a ‘stabbing’, ‘electric shock-like’ or ‘burning’ pain. This pain can last anywhere from a few seconds to several minutes or occasionally longer. Pain attacks can occur multiple times a day in some people whereas others are only affected every so often, for example every few months or even years. The pain attacks may become more frequent and severe as time goes on.
There may be certain ‘trigger points’ on the face when if touched or stimulated, will provoke an attack. For example, shaving, brushing your teeth, chewing, talking or even strong winds onto the face may trigger pain.
What Causes Trigeminal Neuralgia?
Some say that 9 out of 10 cases of trigeminal neuralgia are thought to be caused by a normal, healthy blood vessel pressing on the trigeminal nerve within the skull. This puts pressure on the nerve, making it fire pain signals with minimal provocation, ultimately causing the sensation of severe pain.
Very rarely, trigeminal neuralgia can be caused by other conditions such as multiple sclerosis or tumours (usually benign tumours). Occasionally the cause of trigeminal neuralgia cannot be found.
Who Gets Trigeminal Neuralgia?
Trigeminal neuralgia usually affects older people, commonly starting in people aged 50-60 years old. Women are twice as frequently affected as men.
How Is Trigeminal Neuralgia Diagnosed?
Trigeminal neuralgia is usually a clinical diagnosis. This means that a doctor makes the diagnosis based on hearing your symptoms and examining you.
A scan of the head is sometimes requested. Scans are sometimes requested to rule out other conditions that may be causing the symptoms.
An MRI scan can provide a detailed picture of the relationship between the nerve and adjacent blood vessels if surgery is being considered.
How Is Trigeminal Neuralgia Treated?
Medications are the first line of treatment for trigeminal neuralgia. The drug carbamazepine (Tegretol), which is also used to treat epilepsy, works by dampening down nerve signals and appears to be the most effective drug to control the symptoms. It begins to work after one or two days and must be taken daily to reduce the risk of the symptoms returning. After you have been symptom free for about a month, you may be gradually weaned off the medication.
There are a range of other medications that can be tried if carbamazepine is not effective or you experience unwanted side-effects.
Regular painkilling medications such as paracetamol are not usually adequate to control the pain caused by trigeminal neuralgia on their own.
Surgical Treatment of Trigeminal Neuralgia
Surgery may be an option if your symptoms are not adequately controlled by medications or if the side-effects are intolerable. Different surgical options exist, each with its own pros and cons. The most appropriate treatment for you will depend on your individual circumstances. Advice should be sort from your doctor. Some of the procedures that are most commonly performed in Leeds are described below:
- Thermocoagulation – This is a procedure where a needle is passed through the cheek and guided towards the bottom of the skull near to the beginning of the trigeminal nerve. An electric current is then used to heat the needle to burn the trigeminal nerve.
- Gamma Knife – This is a technique that uses a targeted beam of radiation that can be accurately aimed at the trigeminal nerve tissue to destroy it and prevent it from conducting pain signals. There is usually a delay before people experience any benefit from this procedure and in the short term symptoms may worsen before they get better.
- Microvascular Decompression – This is an operation to directly relieve the pressure on the nerve where a blood vessel is pushing on it (see the ‘what causes trigeminal neuralgia?’ section). This is a relatively major operation that involves making a small hole in the skull just behind the ear to gain access to the trigeminal nerve.
Page Author: Anand Goomany, 2012