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
  • 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.

How is Trigeminal Neuralgia Diagnosed?

After discussing your medical history, your doctor will ask you several questions about the type of pain you are experiencing, such as the location, duration, and triggers. Typically, your doctor will conduct several tests to diagnose trigeminal neuralgia. These include:

  • Neurological examination: By examining different parts of your face, your doctor can pinpoint the painful areas. This will help to determine which branches of the trigeminal nerve are affected. A reflex test will also help your doctor to assess whether your symptoms are the result of a trapped nerve or different condition altogether.
  • Magnetic resonance imaging (MRI): A scan of your head and face can help to determine if the trigeminal neuralgia is caused by a tumor or multiple sclerosis.

Trigeminal Neuralgia Treatment

The Miami Neuroscience Center at Larkin specializes in the treatment of Trigeminal Neuralgia. There are several treatment options for TN, depending on a variety of factors such as your physical health and previous treatment outcomes. Some treatment options for TN include: 

Medical/Drug Therapy Anticonvulsants

The first line of choice is usually the anticonvulsant carbamazepine (Tegretol). Alternative anticonvulsants may be prescribed, these include gabapentin, phenytoin, clonazepam, topiramate, sodium valproate, and oxcarbazepine. Anticonvulsants are a form of medication usually prescribed for epilepsy. In TN, they help to control pain caused by damaged nerves.

Glycerol Injection (Rhizotomy)

This method for treating trigeminal neuralgia is used mainly for elderly patients whose immune system is weakened by other chronic diseases. It involves the injection of a small amount of glycerol (alcohol) into the trigeminal nerve to block pain signals to the brain. The injection has a numbing effect and helps to reduce pain. This procedure may result in partial numbness or tingling in the face.3

Microvascular Decompression

This treatment provides the longest-lasting relief from the pain of trigeminal neuralgia. It is a surgical procedure that is performed under general anesthesia. After shaving a small area behind the ear, the surgeon will remove a small part of your skull. Small pieces of Teflon are inserted between the trigeminal nerve and the nearby blood vessels. This insulates the trigeminal nerve from further direct contact and irritation. A thin metal mesh is used to cover the area where the bone was removed.

Percutaneous Balloon Compression

This is an outpatient procedure that requires general anesthetic. During this minimally invasive procedure, the surgeon will insert a hollow needle through your cheeks and the back of your mouth to reach the trigeminal nerve. A thin, flexible tube with a balloon on one end is threaded through the needle. The balloon is inflated, causing enough pressure to damage the trigeminal nerve and prevent further pain signals from being transmitted.

Radiofrequency Lesioning (Rfl)

Also known as radiofrequency rhizotomy, this minimally invasive procedure is often used to treat severe trigeminal pain in patients who also suffer from other health complications, and for whom an open surgical procedure would be too dangerous. A small electrode is inserted through the cheek and its radiofrequency is used to damage the trigeminal nerve in order to prevent pain signals from being transmitted to the brain. This procedure also causes some facial numbness. Pain will recur after five years in around half of patients treated. When this happens, the procedure may be repeated.

Gamma Knife Radiosurgery

Of all the surgical options for trigeminal neuralgia, this is the least invasive. The gamma knife is a device that transmits controlled beams of radiation to the trigeminal nerve at the point where it enters the brain stem. The radiation damages the nerve so that it is no longer able to transmit sensations of pain to the brain. This procedure is performed on an outpatient basis and requires only local anesthesia. This treatment is effective in around 80 percent of trigeminal neuralgia patients.4

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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.

Alternative treatments to Trigeminal Neuralgia

Acupuncture: Studies show that acupuncture can relieve the symptoms of TN for some people. Care must be taken when inserting the acupuncture needles, to avoid coming into contact with trigger areas, as this may cause a flare-up of symptoms. It does not work for everyone so if you try it, and the first session is unsuccessful, it is unlikely to work at all.

Aromatherapy: Although aromatherapy may not work for everyone, for some it can provide relief from the pain of TN. Essential oils such as St. John’s Wort, chamomile, ginger, and lavender can all help ease neuropathic discomfort. 

Meditation: Meditation can help relieve pain caused by TN. Using techniques which help you slow your breathing and relax, can help to ease or prevent stimulation of the trigeminal nerve. For the best results, don’t wait until you are in pain to practice meditation, practice it daily if only for ten minutes at a time.

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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!