Trigeminal neuralgia

Trigeminal neuralgia (TN) is a type of severe nerve pain that affects your face, making it impossible to eat or drink. Over time, attacks of pain may come more frequently and be increasingly severe.

Causes of trigeminal neuralgia

The trigeminal nerve is located in the cranium, branches into three smaller nerves, and controls most of the feeling you have in your face.

Trigeminal neuralgia is most typically caused by a blood vessel pressing against the trigeminal nerve as it exits the brain stem. It can also appear after facial trauma or dental procedures.

Get an accurate diagnosis

Because there are many possible causes for facial pain, getting an accurate diagnosis is important.

Before looking for trigeminal neuralgia, your doctor may order additional tests to rule out other conditions.

Symptoms of trigeminal neuralgia

Hiker on edge of cliff

Trigeminal neuralgia is the most common facial pain syndrome (diagnosed in roughly 15,000 people every year). It has been described as “the most terrible pain known to man.”

An attack of trigeminal neuralgia is marked by sudden severe, sharp, shooting facial pain that last from a few seconds to about 2 minutes. The pain is often described as excruciating, like an electric shock.

Other symptoms may include:

  • A constant aching, burning feeling.
  • Attacks that become more frequent and intense over time, sometimes lasting days, weeks, months or longer.
  • Bouts of pain lasting from a few seconds to several minutes.
  • Pain affecting one side of the face at a time.
  • Pain focused in one spot or spread in a wider pattern.
  • Pain in areas supplied by the trigeminal nerve, including the cheek, jaw, teeth, gums, and lips; or less often, the eye and forehead.
  • Spontaneous attacks of pain or attacks triggered by things such as touching the face, chewing, speaking or brushing teeth.

Diagnosing trigeminal neuralgia

Because there are many possible causes for facial pain, getting an accurate diagnosis is important.

Before looking for trigeminal neuralgia, your doctor may order additional tests to rule out other conditions. Typical tests or procedures your doctor will use to diagnose trigeminal neuralgia include:

Physical and neurological examinations. By thoroughly examining parts of your face, your doctor can discover the exact source of the pain and can determine which parts, if any, of the trigeminal nerve may be involved. They may also perform reflex tests to decide if your symptoms are caused by a compressed nerve or another condition.

Magnetic resonance imaging (MRI). Your doctor may order an MRI to rule out other possible causes for the TN, including multiple sclerosis and a tumor. In some cases, your doctor may inject a dye into a blood vessel to view the arteries and veins and highlight blood flow (magnetic resonance angiography).

Woman and provider looking at tablet

Treatments for trigeminal neuralgia

Medications

Some seizure medications have been shown to successfully treat the symptoms of trigeminal neuralgia, including carbamazepine, gabapentin and similar agents.

Procedures

If medication is an ineffective approach, there are several procedures available that have been shown to help control trigeminal neuralgia pain.

Rhizotomy. A rhizotomy is an outpatient procedure performed under general anesthesia that eliminates the pain-causing fibers within the trigeminal nerve. There are several forms of rhizotomy, but each procedure is minimally invasive and only takes a few minutes to complete.

Glycerol rhizotomy. This procedure requires you to be put under general anesthesia while sitting upright. During the procedure, a long needle is placed into the cheek and guided back to the trigeminal nerve ganglion, the point where the trigeminal nerve splits into three branches. Once there, a small amount of clear, colorless chemical called glycerin is injected. Within an hour, the chemical slowly deadens the nerve fibers responsible for causing trigeminal neuralgia pain.

As with any procedure involving anesthesia, there’s a recovery time to be expected. For a glycerol rhizotomy, that typically takes several hours.

Although this procedure often relieves pain, there’s a fairly high recurrence within a year to two years as the nerve regrows. The procedure can be repeated as many times as necessary to obtain relief.

Nurse talking to patient

Stereotactic radiosurgery. Also known as CyberKnife or Gamma Knife treatment, stereotactic radiosurgery treats trigeminal neuralgia by aiming a precise beam of radiation at the trigeminal nerve to relieve the pain. The procedure takes about 45 minutes, is painless, and doesn’t require anesthesia. Stereotactic radiosurgery brings significant pain relief to around 70% of patients within several weeks. The relief isn’t permanent but may last for several years. In some cases, the nerve may regenerate, and the pain may resume.

Side effects associated with stereotactic radiosurgery are minimal and may include fatigue and facial numbness. This procedure should be performed no more than two times since it involves relatively high doses of radiation delivered near the brain.

Microvascular Decompression (MVD). This procedure is the longest-lasting treatment for trigeminal neuralgia, bringing pain relief to about 80% of people. To be eligible, you need to be in good health, able to tolerate surgery and general anesthesia, and be able to accommodate a 4- to 6-week recovery period.

The surgery, which takes 2 to 3 hours, involves placing a piece of Teflon between the blood vessel and the trigeminal nerve that prevents additional rubbing or compression.

Recovery time typically requires a couple of days in the hospital. Patients can expect fairly immediate pain relief from the MVD procedure.

In some cases, the blood vessels may grow back, causing a return of trigeminal neuralgia pain. If this occurs, you will likely have to seek alternate treatment options as the MVD procedure is infrequently repeated.

Frequently asked questions (FAQs) about trigeminal neuralgia

The trigeminal nerve is located in the cranium, branches into three smaller nerves, and controls most of the feeling you have in your face.

  • The ophthalmic nerve is responsible for feeling in the upper eyelid and forehead.
  • The maxillary nerve is responsible for feeling in the lower eyelid, cheek, nostril, upper lip and upper gum.
  • The mandibular nerve is responsible for feeling in the jaw, lower lip, lower gum and other muscles in the mouth.

Trigeminal neuralgia pain doesn’t resolve on its own and tends to be cyclical, with long periods of multiple attacks and even longer periods of little or no pain. Over time, attacks of pain may come more frequently and be increasingly severe.

The trigeminal nerve cannot repair itself and there is no cure for trigeminal neuralgia. However, treatments are available to alleviate the associated pain, from antiseizure medications to surgery options, as detailed on this page.

Recovery time depends on the type of procedure you undergo. Most TN surgeries, like rhizotomy and stereotactic radiosurgery, are done on an outpatient basis and full recovery takes several days. Other, more involved procedures like microvascular decompression require general anesthesia and therefore a hospital stay of 2 to 3 days and a recovery time of 4 to 6 weeks.

Some degree of facial numbness is expected after many of these procedures, and trigeminal neuralgia will often return even if the procedure is initially successful.

Although TN attacks don’t increase in intensity over time, they do tend to occur more frequently, with fewer and shorter pain-free periods before they recur. As the pain-free intervals begin to disappear, medications prescribed to control the pain also tends to become less effective. This can have a cumulative, debilitating effect both physically and emotionally.

TN isn’t cause by stress, but there are signs that it can aggravate the condition. Studies have shown that chronic pain can lead to stress-induced heightened pain sensitivity. This can create a cycle where patients experience pain, and then after the pain subsides, are worried and have anxiety about experiencing triggers that would cause additional flareups.

Certain foods and certain temperatures of foods seem to trigger attacks in some people, so you may want to consider avoiding things such as:

  • Caffeine.
  • Citrus fruits and bananas.
  • High-sugar foods.
  • Hot, cold or spicy foods.
  • Junk foods and highly-processed foods.

Knowing what foods can trigger trigeminal neuralgia symptoms can help you avoid flareups.

In general, it’s important to eat healthy meals and, if you’re having problems chewing, make sure you either eat mushy foods or blend up your meals.

Note too that while there isn’t a vitamin that’s been proven to mitigate symptoms, vitamin B12 has been found to be a pharmacological useful tool for patients with neuropathic pain.