Conditions We Treat

Trigeminal Neuralgia

What is Trigeminal Neuralgia?

Trigeminal neuralgia is a complex pain syndrome that affects one particular nerve in your face. This nerve, the trigeminal nerve, is located just in front of your ears on either side of the head and has three major branches.

The ophthalmic nerve (the upper branch): This nerve branch involves the scalp and forehead, the upper eyelid, the eye, the nose, and the frontal sinuses
The maxillary nerve (the medial branch): The medial branch involves the lower eyelid, cheek, upper lip, teeth, gums, nose, palate, part of the back of the throat, and most of the sinus
The mandibular nerve (the lower branch): This branch is responsible for motor function and also works the lower lip, teeth, gums, the floor of the mouth, the front of the tongue, the chin, the jaw, and parts of your external ear

All three branches affect the sensory nerves of the face and motor nerves of the muscles that you use for chewing and swallowing.

What causes Trigeminal Neuralgia?

Trigeminal neuralgia has a variety of causes. The majority of the time, pressure on the trigeminal nerve root is the leading cause. This pressure may be due to a swollen, inflamed artery in the head that is applying pressure to the area, or it may be due to some other injury or trauma. Occasionally, the place where the nerve root enters the skull also becomes narrower, causing pressure. Other causes of compression include the following:

Tumors (vestibular schwannoma or meningioma)
Epidermoid cyst
Aneurysm (bulging of a blood vessel)
Trauma
Lupus
Shingles (herpes zoster)
Multiple sclerosis

If the nerve compression continues, it can cause damage to the protective covering of the nerve called the myelin sheath. Once this myelin sheath is damaged, the nerve begins to respond unpredictably. As a result, the nerve can act erratically, causing pain at the lightest touch, chewing, or brushing the teeth.

What are the symptoms of Trigeminal Neuralgia?

The symptoms of trigeminal neuralgia are unmistakable. The most frequent symptom is sudden, severe, stabbing, recurrent episodes of pain on one side of the face that are recurring. This pain occurs most often on just one side of the face but can occur on both. A constant aching or burning sensation, or a tingling sensation or aching preceding the pain episodes, has been reported by some patients. Symptoms include:

Attacks of pain lasting from a fraction of a second to two minutes that affect one or more of the innervated areas of the trigeminal nerve
Intense, sharp, superficial, or stabbing facial pain
Burning, constant facial pain
Pain appears with identifiable triggers
Attacks are stereotyped in the individual patient
There are no clinically evident neurologic deficits
Pain that cannot be attributed to another disorder

Pain can be triggered by the slightest contact, including the following:

Slight breeze
Washing the face
Shower spray
Brushing teeth
Applying makeup
Sneezing
Brushing hair
Eating
Talking
Drinking

The intense pain can be triggered by any vibration or contact with the face, eyes, head, or mouth. These attacks can last from several seconds to a couple of minutes and may recur over subsequent hours to weeks. The pain episodes may then disappear for months to years before recurring. Trigeminal neuralgia pain rarely occurs at night during rest and tends to affect women slightly more than men. Another cause of facial pain can be postherpetic pain, which usually occurs with a persistent rash that involves the ophthalmic branch. It may also be a form of migraine pain, which is usually more prolonged and often throbbing. If a tumor is present, or high blood pressure or stroke is suspected, your treatment options will be much different. This is why eliminating other issues is crucial. Trigeminal neuralgia can be difficult to diagnose. Many patients are misdiagnosed with migraine pain and may wait years for proper diagnosis and relief. It is important to find a pain specialist who has received specialized training to examine and diagnose trigeminal neuralgia.

What are my treatment options for Trigeminal Neuralgia?

Trigeminal neuralgia is just as challenging to treat as it is to diagnose. Once diagnosed, it’s important to start treatment right away. There are four types of trigeminal neuralgia treatments.

Medications such as anti-inflammatory, anticonvulsant, and antidepressant medications may be the first method to treat the pain. Most pain physicians recommend periodically tapering medications down in patients experiencing pain relief in order to check for the occasional permanent remission.
Local anesthetic blocks may occur after or in conjunction with medications but are only temporary
Surgery may provide relief when the more conservative options have failed. One of the surgical procedures that may help is Radiofrequency ablation (RFA).
Alternative and complementary treatments such as Peripheral nerve stimulation (PNS) or spinal cord stimulation (SCS) are minimally-invasive treatment options that replace pain signals with a mild tingling sensation. These treatments may offer the potential for long-term management of pain without invasive treatment or prescription medications. Because there is a trial period for SCS or PNS, these procedures are less invasive, reversible, adjustable, and testable for patients in pain.

Acupuncture has provided short-term pain relief in some patients, biofeedback or meditation has helped others learn to manage their response to pain. While biofeedback and meditation do not “cure” the underlying cause of your pain, they can help you to feel more equipped to manage it when it flares up.

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If you’re struggling with neck, back, or hip pain or any other spine related issues, schedule an appointment with us today to get back to living your life the way you’d like to.