Trigeminal neuralgia

  • Definition
    • Trigeminal neuralgia (TN) is a nerve disorder. It causes a stabbing or electric shock-like pain in parts of the face.

  • Alternative Names
    • Tic douloureux; Cranial neuralgia; Facial pain - trigeminal; Facial neuralgia; Trifacial neuralgia; Chronic pain - trigeminal; Microvascular decompression - trigeminal

  • Causes
    • The pain of TN comes from the trigeminal nerve. This nerve carries the sensations of touch and pain from the face, eyes, sinuses, and mouth to the brain.

      Trigeminal neuralgia may be caused by:

      • Multiple sclerosis (MS) or other diseases that damage the protective covering myelin of the nerves
      • Pressure on the trigeminal nerve from a swollen blood vessel or tumor
      • Injury to the trigeminal nerve, such as from trauma to the face or from oral or sinus surgery

      Often, no cause is found. TN usually affects adults, but it can occur at any age. When TN affects people younger than 40, it is often due to MS or a tumor.

  • Symptoms
    • Symptoms may include any of the following:

      • Very painful, sharp electric-like spasms that usually last a few seconds or minutes, but can become constant.
      • Pain is usually only on one side of the face, often around the eye, cheek, and lower part of the face.
      • There is usually no loss of sensation or movement of the affected part of the face.
      • Pain may be triggered by touch or sounds.

      Painful attacks of trigeminal neuralgia can be triggered by common, everyday activities, such as talking, brushing teeth, chewing, drinking, eating, touching the face, or shaving.

  • Exams and Tests
    • A brain and nervous system (neurologic) examination is often normal. Tests that are done to look for the cause may include:

  • Treatment
    • Your primary care doctor, a neurologist, or a pain specialist may be involved in your care.

      Certain medicines sometimes help reduce pain and the rate of attacks. These medicines include:

      • Anti-seizure drugs
      • Muscle relaxants
      • Tricyclic antidepressants

      Surgery is an option for TN. But, the true benefits of surgery are not fully proven.

      One surgery is called microvascular decompression (MVD). During surgery, material is placed between the nerve and the blood vessel that is pressing on the nerve.

      Other techniques involve destroying or cutting parts of the trigeminal nerve root. Methods used include:

      • Radiofrequency ablation (uses high-frequency heat)
      • Injection of glycerol or alcohol
      • Balloon microcompression
      • Radiosurgery (uses high power energy)

      If a tumor is the cause of TN, surgery is done to remove it.

  • Outlook (Prognosis)
    • How well you do depends on the cause of the problem. If there is no disease causing the problem, treatment can provide some relief.

      In some people, the pain becomes constant and severe.

  • Possible Complications
    • Complications may include:

      • Side effects of medicines used to treat TN
      • Problems caused by procedures, such as loss of feeling in the treated area
      • Weight loss from not eating to avoid triggering pain
      • Avoiding other people if talking triggers pain
      • Depression, suicide
  • When to Contact a Medical Professional
    • Call your health care provider if you have symptoms of TN, or your TN symptoms get worse.

  • References
    • Garza I, Schwedt TJ, Robertson CE, Smith JH. Headache and other craniofacial pain. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 103.

      Paterno J, Singla A. Trigeminal neuralgia. In: Frontera WR, Silver JK, Rizzo TD, eds. Essentials of Physical Medicine and Rehabilitation. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 117.

      Zakrzewska JM, Chen HI, Lee JYK. Trigeminal and glossopharyngeal neuralgia. In: McMohan SB, Koltzenburg M, Tracey I, Turk DC, eds. Wall & Melzack's Textbook of Pain. 6th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 66.