Trigeminal neuralgia is pain caused by damage to the trigeminal nerve. It is characterized by a stabbing pain in the face that can result from almost any facial movement. It tends to be extremely painful and can interfere with activities of daily living. Trigeminal neuralgia is frequently an initial symptom of multiple sclerosis (MS), and it is commonly confused with dental pain. Between 1.9 to 4.9 percent of MS patients experience it.
Neuralgia
The term neuralgia is used to describe pain that radiates along the path of a nerve. In some cases the cause is unknown, but the condition can be caused by some drugs, irritation from chemicals, kidney problems, diabetes, infections, pressure on nerves or from an injury. Trigeminal neuralgia is the most common type and involves facial pain.
Neuralgia can occur at any age, but it is most common among the elderly.
Neuralgia is not life-threatening, but the pain can be severe. A pain specialist can suggest ways to control the pain.
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See All 3 AnswersTreatment of trigeminal neuralgia consists of medical and surgical approaches. Initially, the patient is offered treatment with anticonvulsants, such as carbamazepine or oxcarbazepine, which may be quite effective in the early stages. However, the side effects such as sedation, dizziness and unsteadiness may limit the use of these medications.
Approximately 50 percent of patients who get initial relief with medications eventually will need surgical therapy for their trigeminal neuralgia. The two most popular procedures are: gamma knife radiosurgery and micro vascular decompression. Gamma knife radiosurgery causes partial radiation injury to the trigeminal nerve and is entirely noninvasive, outpatient and painless. The main disadvantage is that the therapeutic effect is delayed by up to two months. The sensation to the face may be impaired in small percentage of patients. Micro vascular decompression is a major neurosurgical procedure, which is performed through a small opening in the back of the skull. The effect of the treatment is immediate and there is no risk of sensory loss the face.
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UCLA Health answeredOver time, some patients, although they’re getting reasonable relief, have to take such high doses of medications that they begin to develop side effects that are quite disabling. The side effects can include memory impairment and an inability to concentrate, a foggy feeling, and mental impairment. In extreme cases, the side effects include unsteadiness in walking, loss of balance, and dizziness.
We see a number of patients who’ve been on medication for years in whom the side effects have become so unacceptable that they’re looking for another alternative. -
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UCLA Health answeredThe MRI scan is not necessarily and specifically intended to make the diagnosis of trigeminal neuralgia, because very often, the blood vessel causing the compression on the nerve is small enough that you can't see it clearly. Even patients with no facial pain often have blood vessels close to the trigeminal nerve, so it's difficult to make the diagnosis specifically by the MRI scan. It's not like a brain tumor, where the MRI scan makes the diagnosis.
The MRI scan is specifically intended to rule out other causes of facial pain, in some cases tumors. For example, a meningioma can cause facial pain. Blood vessel abnormalities like an arteriovenous malformation can also cause pain. Multiple sclerosis is one of the primary reasons that we do the MRI scan because multiple sclerosis will show up both in the cerebral hemispheres as well as the area of the brain stem and the trigeminal nerve. So if we see multiple sclerosis, then microvascular decompression is not the choice for the therapy. Specific therapy for the multiple sclerosis and symptomatic treatments are a better choice. -
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UCLA Health answeredThe pain most commonly involves what are called the first and second divisions of the trigeminal nerve. The trigeminal nerve splits into three different divisions. The first division involves the eye and the forehead. The second division is the cheek, and the third division is the jaw.
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UCLA Health answeredOne of the newer agents that can be effective in some trigeminal neuralgia cases is called Lyrica. Antidepressants can be effective, not because the individual is depressed but because the drugs have a biochemical effect on nerve function that may improve trigeminal neuralgia. Stereotactic radiosurgery also helps in some of these cases.
Another option is the needle procedure in the face, and some studies suggest it that may be a little bit more effective than the stereotactic radiosurgery. The one that we tend to favor now and recommend, called balloon compression, seems to be a good alternative. It's not a high-risk procedure, and it's something that can be done effectively in many, many cases. -
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UCLA Health answeredThe most common neuralgia type is trigeminal neuralgia. Trigeminal neuralgia refers to a disorder of the trigeminal nerve, the three-part nerve that provides sensation to the upper face, the mid face, and the lower face, the three divisions of the trigeminal nerve.
Trigeminal neuralgia usually occurs in people over the age of 40 or 50. It is episodic, sharp, stabbing electroshock-type pain. It occurs very suddenly, and it lasts a few seconds. It can last 10 or 15 seconds, or the episodes can keep coming for many minutes, but between the episodes of pain in trigeminal neuralgia, people don't have pain. Trigeminal neuralgia is often precipitated or brought on or triggered by eating or laughing or talking, but it can also be triggered just by touching a certain spot on the face. Men say that when they shave, it triggers the episodes of pain. Women say when they put on their makeup, it can trigger the pain. One's face can be so sensitive that even cold wind blowing on the face can trigger these sharp, shooting attacks.
Trigeminal neuralgia is one of the worst pains known. It's often called the suicide disease because the episodes of pain are so incredibly severe that historically, before we had treatments, people have actually committed suicide to get away from that kind of pain. -
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UCLA Health answeredMotor cortex stimulation involves putting a small grid of electrodes through an opening made in the skull, over the motor cortex. This is the area of the cerebral hemisphere that controls movements. The right motor cortex controls movement on the left side of the face and the left side of the body, so if one has pain in the left side of the face, then an electrode over the right motor cortex has been used. Motor cortex stimulation is not a common operation.
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UCLA Health answeredThere’s not a direct biological comparison as far as we know between migraines and trigeminal neuralgia. Migraine headaches don’t cause trigeminal neuralgia and vice versa. However, it certainly is possible for patients with trigeminal neuralgia and severe facial pain to experience headaches as well. Those are secondary headaches that are a result of the severe facial pain.
Migraine headaches are a separate disorder that involves the blood vessels and other structures involving the brain. The typical migraine headache is differentiated because it’s a pounding headache often associated with nausea and vomiting and sometimes associated with other neurological symptoms, like flashing lights or hazy vision off to one side. The two really are different. -
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UCLA Health answeredFor young healthy patients who have severe trigeminal neuralgia, there really is no better option than microvascular decompression (MVD) as long as they’re wiling to undergo surgery and the two-or three-day hospitalization associated with that surgery and recovery. The recovery process often takes four weeks, give or take. The radiation therapy is a good option for elderly patients or patients with significant medical problems for whom open surgery is too risky or for whom anesthesia may be too risky.