Trigeminal Neuralgia

Facial Pain

What is Trigeminal Neuralgia?

Trigeminal Neuralgia (TN) is a chronic condition that can cause intense pain in one or the other side of the face or jaw. Although TN can affect adults of any age, it is more prevalent in people over 50 years of age. The pain of TN can be both physically and psychologically devastating and is often likened to repeated electric shock. This condition affects around 15,000 people per year in the U.S. and is commonly misdiagnosed as a psychological or dental problem.1

What is the Trigeminal Nerve?

The trigeminal nerve is the largest of the cranial nerves. It plays a vital role in facial sensory and motor functions, such as chewing and biting. Each hemisphere of the face has a trigeminal nerve, this is why patients generally have symptoms on only one side of their face; when one nerve is affected.

The trigeminal nerve breaks off into three branches:

  • Ophthalmic: This division consists of a sensory nerve that transports stimuli such as pain, temperature, and touch from the upper eyelids to the crown of the head.
  • Maxillary: This division is also a sensory nerve, and carries stimuli that arise in the middle of the face.
  • Mandibular: This division is a sensory and motor nerve. The sensory component carries stimuli from the lower third of the face. The motor component is connected to the pharyngeal muscles, which surround the pharynx (the nasal cavity and throat).2 This branch of the trigeminal nerve can cause pain in the jaw and lower face.

The Trigeminal Nerve and Pain Areas


Miami Neurosurgeon Dr. Azik Wolf Explains Trigeminal Neuralgia

What Are the Types of Trigeminal Neuralgia?

 TN Type 1 (Classical TN or Typical TN)TN Type 2 (Symptomatic or Atypical TN)
Pain intensityIntense painDull pain
FrequencyEpisodic painConstant pain
Difficulty to treatLess difficultMore difficult
Common CauseBlood vessels (generally the superior cerebellar artery)Idiopathic (unknown), multiple sclerosis or other diseases causing damage to the myelin sheath
LikelihoodLess common in people under 40Affects any age
SexMore likely in womenMore likely in women
Affected facial regionMouth, cheek, or nose on one side of the faceGreater portion of the face

Trigeminal neuralgia may be progressive. This means that the symptoms may worsen over time. For example, initially, the pain may arise in the upper or lower jaw. Often this causes sufferers to think that the discomfort is due to a dental problem. Over time, the intervals between attacks may become shorter or may disappear altogether. Pain medication may also become less effective than it was initially.

Trigeminal Neuralgia Symptoms

Trigeminal Neuralgia generally results in debilitating pain on one side of the face originating in the jaw or lower half of the face. The sensation is often described as: burning pain, stabbing pain, aching pain, electric shocks, or toothache.

In the earlier stages of TN, you’ll experience brief periods of episodic pain lasting seconds at a time. Time be­tween episodes can vary from seconds to hours, or there can be days or months between attacks. 

Trigeminal Neuralgia Causes

Trigeminal Neuralgia occurs when the trigeminal nerve is compressed and becomes inflamed. Commonly, the compression is due to enlarged blood vessels that come in contact with the trigeminal nerve. It is not known why this may occur. Multiple Sclerosis and other conditions, such as optic neuritis or Devic’s disease,  that cause damage to the myelin sheath can also result in this condition. The myelin sheath is a sheet composed of lipids, proteins, and other substances that wraps around nerve fibers, providing insulation and protection, and enhancing electrical signals. Other causes include:

  • Blood Vessels: Most cases of trigeminal neuralgia are caused by compression of the trigeminal nerve. This can happen when the blood vessels wrap around or grow over the nerve. Why this occurs is not understood.
  • Brain Tumors and cysts: Tumors and cysts can either put pressure on the trigeminal nerve directly or can cause surrounding blood vessels to press against the nerve.
  • Aneurysms: An aneurysm is a blockage or bulge in the wall of a blood vessel. This can also put pressure on the trigeminal nerve. 
  • Virus: Viruses such as chickenpox, shingles, and herpes can also result in trigeminal neuralgia.
  • Trauma: In some cases, trigeminal neuropathic facial pain may be a result of facial injury or trauma, stroke, or surgery on the ear, nose, or throat.

Trigeminal neuralgia may also be idiopathic, which means it may develop without any identifiable cause.

Trigeminal Neuralgia Risk Factors

Common risk factors associated with this condition include:

  • Sex: Women are more likely to develop trigeminal neuralgia than men.
  • Age: The risk of developing trigeminal neuralgia increases with age. It is higher in people who are between the ages of 50 and 60 years of age. This is mainly due to the elongation and hardening of the blood vessels and brain sagging, which can create new contacts between nerves and blood vessels.
  • Multiple sclerosis: Multiple sclerosis is a chronic disease that can affect the brain, spinal cord, and optic nerves. Because it also affects the protective myelin coating of the nerves, it can lead to trigeminal neuralgia.

If you or someone you love has been diagnosed with TN, there is help.

It is our aim at Miami Neuroscience Center at Larkin to treat this condition cost-effectively while providing high-quality care and optimal outcomes. Explore all of our treatment options and meet the top trigeminal neuralgia specialists in Miami, call us today to learn more about managing your pain.

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Support group: Living with Trigeminal Neuralgia

The symptoms of TN are so profound that they can have a detrimental effect on a patient’s quality of life. TN may even cause psychological effects such as:

  • Depression
  • Anxiety
  • Reclusion from social interactions
  • Restriction of daily activities

Patients with TN often experience anxiety and depression because these unpredictable chronic pain episodes make everyday activities impossible. It can also cause difficulty in falling asleep. If you are suffering from anxiety or depression due to TN, you should talk to your doctor about available treatment options. Other things you can do to ease the burden of living with TN include:

Join a support group: Joining an online community can be beneficial for TN sufferers. It can give you access to discussions with other sufferers, medical resources, videos, events, and lots of TN information. 

Keep a TN journal: Keeping regular notes about your experience of TN can help you get to understand your triggers so you know what to avoid, It can also help you spot any other patterns to your TN symptoms, such as signs of stress and dietary factors.

Maintain healthy habits: Regardless of your symptoms of TN, you should incorporate healthy habits into your daily routine. This means eating meals regularly throughout the day, getting an adequate amount of sleep, and exercising regularly.

FAQ - Frequently Asked Questions

Trigeminal neuralgia can be triggered by light touching or stimulus such as:

  • Touching your face
  • Eating
  • Brushing your teeth
  • Shaving
  • Cool breeze

Trigeminal neuralgia is the most common cause of facial pain. In the United States alone, around 15,000 people are diagnosed each year.

TN affects one side of the face. For most people, it affects the right side. No other areas of the body are affected.

This condition cannot always be cured, though relief from pain is possible.

It is extremely rare for symptoms of this condition to occur during sleep.

This condition is not passed on genetically.

References

NORD "Trigeminal Neuralgia" National Organization for Rare Disorders (NORD). https://rarediseases.org/rare-diseases/trigeminal-neuralgia/

Lorenzo Crumbie, Francesca Salvador & Adrian Rad "Trigeminal nerve (CN V)" https://www.kenhub.com/en/library/anatomy/the-trigeminal-nerve

National Institute of Neurological Disorders and Stroke "Trigeminal Neuralgia Fact Sheet" NIH June 2013. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Trigeminal-Neuralgia-Fact-Sheet

Douglas Kondziolka, MD, MSc, FRCSC; Bernardo Perez, MD; John C. Flickinger, MD "Gamma Knife Radiosurgery for Trigeminal Neuralgia" Jama Network, December 1998. https://jamanetwork.com/journals/jamaneurology/fullarticle/774556

To see if you are candidate for our pain management program please call us at 786.871.6856 or schedule a consultation today!