What Is Trigeminal Neuralgia?

Ever have facial pain that hits out of the blue, causing short bursts of agony in the upper or lower jaw, cheek or forehead area? While numerous factors such as stress or dental problems can cause pain in these parts of the head, one often overlooked cause is trigeminal neuralgia.

The trigeminal nerve is the fifth cranial nerve that supplies the sensation to the face. Trigeminal neuralgia occurs when there can be compression of the nerve as it’s coming of the brain most commonly by an artery or tumor but sometimes the etiology is unknown. This can cause severe episodic stabbing, electrical sensation in the face that could be triggered by minor things such as chewing.

Trigeminal neuralgia is caused by irritation of the trigeminal nerve. This nerve branches across the surface of the head and carries feelings from the forehead, middle face, mouth and jaw back to the brain.

Trigeminal neuralgia is more common in women, people 50 years of age or older and those who have multiple sclerosis (MS). In people with MS, trigeminal neuralgia can develop due to the degrading of the protective myelin coating of the trigeminal nerve. Other causes include trauma due to accident or surgery, pressure on the nerve caused by a blood vessel or, more rarely, a tumor.

Symptoms of Trigeminal Neuralgia

The main symptom of trigeminal neuralgia is pain.

Trigeminal neuralgia has two variants, known as T1 and T2. In T1, pain comes in short, intense bouts. These bouts can sometimes be triggered by touching a sensitive part of the mouth, jaw or face. In T2, the pain is more sustained. After an attack of trigeminal neuralgia, a patient may experience facial tremors or spasm.

Diagnosing Trigeminal Neuralgia

People with trigeminal neuralgia may think they have an abscessed tooth or a migraine. To determine what is causing facial pain, a doctor will go through the symptoms and medical history and perform a physical exam . After other causes have been ruled out, an MRI may be ordered to look for compression of the trigeminal nerve.

Treatments for Trigeminal Neuralgia at Western Neuro

Treatment is usually initiated with medications. Patients may initially respond well but later either start experiencing frequent episodes or stop responding to medications. Surgical treatment includes direct decompression of the nerve from the offending vessel via small incision behind the ear where a piece of bone is removed from the skull to access the brain where the trigeminal nerve is located. The offending artery is then gently lifted off and small piece of synthetic material is placed between the nerve and the artery to prevent the artery from directly contacting the nerve. In experienced hands, this provides the highest success rates and best long-term relief. Other options include glycerol or alcohol injections directly to the nerve and gamma knife surgery.

Medical treatments for trigeminal neuralgia include:

• Antiseizure medicines
• Muscle relaxants
• Tricyclic antidepressants

When medication no longer controls symptoms, surgery may be an option. He or she may suggest a procedure to damage or remove a portion of the nerve responsible for the pain. Procedures to treat trigeminal neuralgia include:

• Balloon compression of the affected nerve
• Injections of agents to damage nerve fibers
• Microvascular decompression to move the nerve away from a blood vessel that may be pressing on it
• Neurectomy, or surgically removing part of the affected nerve
• Radiofrequency ablation to damage the nerve with heat
• Stereotactic radiosurgery to create a scar that disrupts the nerve’s communication with the brain

Hemifacial Spasm

The seventh cranial nerve supplies the muscles to the face. In hemifacial spasm there can be compression of the nerve by an artery, which can irritate the nerve and make it hyperactive. Patients can get uncontrolled spams and twitching of the facial muscles on the side of the nerve being affected. Treatment options include Botox to temporarily relax the facial muscles.

Surgical option includes microvascular decompression, much like the approach for trigeminal neuralgia, in which a small piece of synthetic material is placed between the nerve and the offending artery.