Trigeminal Neuralgia

Trigeminal neuralgia, also called tic douloureux, is a common and treatable facial pain syndrome. The trigeminal nerve has three separate branches that carry sensory information from the face to the brain. Trigeminal neuralgia usually occurs when a blood vessel presses against the nerve and damages its insulation. Multiple sclerosis and skull base tumors can also damage the nerve insulation and cause trigeminal neuralgia. This damage to the insulation results in severe, stabbing, electric shock like pain coursing along the nerve root.

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Symptoms

Trigeminal neuralgia causes sudden episodes of sharp, intense facial pain that occur in brief bursts, often described as “stabbing” or “electrical shock-like” pain. Symptoms typically occur on one side of the face. 

Pain can be triggered by light touch around the mouth and face, talking, brushing teeth, eating, a cold or light breeze – or even without a trigger. It stops during sleep, but often returns upon awakening.

Atypical symptoms can include constant pain with a dull or burning sensation that is not caused by a trigger.


Diagnosis

Trigeminal neuralgia is diagnosed through a patient’s history, symptoms and a neurological examination. Imaging studies of the brain – usually a computed tomography (CT) or magnetic resonance imaging (MRI) scan – are also performed to exclude the possibility of a small tumor or the possibility of multiple sclerosis (MS).

In addition to the standard MRI scan, a special high-resolution MRI can directly visualize the trigeminal nerve and see whether a blood vessel is pressing against it.


Treatment

In some patients, the pain is mild and goes away without any treatment. In others, medication can be successfully used to manage the condition for many years. Some of these medications, which are often used for controlling seizures, and can be very effective for trigeminal neurlagia. Our team will help select the best drug and dosage for you to relieve pain and minimize side effects.

If medical management is not effective or the medication side effects are excessive, other treatment may be considered:

  • Stereotactic radiosurgery (CyberKnife®) – A pinpoint radiation beam delivered through robotic technology causes a slow-forming lesion on the nerve to keep it from sending painful sensory signals to the brain. Long-lasting pain relief occurs gradually over two to six weeks and may take several months to reach maximum effectiveness. This noninvasive procedure is painless and performed without anesthesia.
  • Percutaneous glycerol rhizolysis – In this minimally invasive procedure, a small needle is inserted through a patient’s cheek toward the skull base. Using x-ray guidance, the needle is used to inject glycerol into a part of the trigeminal nerve. The glycerol disrupts the transmission of painful sensory signals to the brain. Pain relief is usually immediate and the procedure can be repeated if symptoms return.
  • Microvascular decompression – In this procedure, a neurosurgeon makes a small opening in the bone behind the ear and carefully moves the artery pressing against the trigeminal nerve away from the nerve using microsurgical techniques and GPS-like navigation. A soft Teflon™ cushion is inserted between the nerve and the artery to prevent the artery from compressing the nerve. Most patients have immediate pain relief after surgery.

Our team will closely monitor you and personalize your follow-up care. Our patient navigator will also connect you with our support group and other resources. Learn more