Trigeminal Neuralgia

What is trigeminal neuralgia?

Trigeminal neuralgia is a painful condition that causes an extreme burning, electric or shock-like pain in the face. The pain can be so extreme that it can get in the way of normal activity. Even the fear of oncoming attacks can be so stressful that performing day-to-day tasks is a challenge.

Symptoms of trigeminal neuralgia

The pain from trigeminal neuralgia may last a few seconds or minutes, then ease and then recur. Usually, these cycles of pain occur for a few days or weeks, and then stop for days, weeks or even years before returning. Over time, the cycles tend to recur more quickly, with shorter breaks in between.

The pain sometimes is triggered by very normal activities, such as chewing, smiling, talking, shaving or brushing your teeth. At times, even the wind on your face can cause pain to start.

Some people who have trigeminal neuralgia notice numbness or tingling of the face in the days leading up to an attack.

What causes trigeminal neuralgia?

Trigeminal neuralgia occurs when the trigeminal nerve is pinched or damaged. The trigeminal nerve connects many different parts of your face to your brain. It is made up of three branches. The upper branch links the brain to the scalp and forehead. The middle branch connects to the cheek, side of the nose, top lip, and upper jaw, teeth, and gums. The lower branch extends to the lower jaw, teeth, gums, and bottom lip.

Often, the damaged area of the nerve is located at the base of the brain where the nerve leaves the skull and extends to parts of the face. The nerve may be damaged from a blood vessel that grows too close and presses on the nerve or wears away the nerve’s protective coating (called myelin). Damage to the nerve also can result when extra pressure is put on the nerve by something else, such as a tumor. In many cases, a cause of the nerve damage cannot be found.

How is trigeminal neuralgia diagnosed?

No one specific test can confirm you have trigeminal neuralgia. Often, the diagnosis is made by ruling out other possible causes of your pain. Your doctor may try to pinpoint the cause by asking you questions about your symptoms and medical history. He or she may check for other things that could be causing your pain, such as jaw, sinus, or tooth problems.

Your doctor may order a type of brain scan called magnetic resonance imaging (MRI) to see if a blood vessel is pressing against your trigeminal nerve. An MRI can also look for signs of a tumor or other problems.

Can trigeminal neuralgia be prevented or avoided?

Anyone can get trigeminal neuralgia, so you can’t really prevent it. It’s more likely for people older than 50 years of age. It’s also more common in people who have multiple sclerosis. This is because multiple sclerosis damages the myelin that protects the nerves. Women are more likely to get it than men. The condition seems to be passed down in families, probably because relatives’ blood vessels form in similar ways.

Trigeminal Neuralgia treatment

Trigeminal neuralgia can be treated in many different ways. As with many disorders, some treatments will work well for some people and less so for others. Don’t get discouraged if the first treatment you try doesn’t work. Let your doctor know how you are doing and ask about other options.

Your doctor may prescribe an antiseizure, or antispasmodic drug. These medicines change how nerves transmit information, or how the nerves “fire.” That is why they can help with the pain caused by trigeminal neuralgia. Examples of these medicines include carbamazepine, clonazepam, gabapentin, lamotrigine, oxcarbazepine, phenytoin, topiramate and valproic acid.

Certain types of antidepressants can also be useful in the treatment of pain associated with trigeminal neuralgia. Antidepressants alter the chemical action in your brain that leads to sensing pain. Some examples include amitriptyline, bupropion, doxepin, duloxetine, imipramine, paroxetine, nortriptyline, and venlafaxine.

Combinations of two or even three medications may be more effective than a single medication. Often, a lot of time is spent in trying different medications and combinations of medications to find the most effective medical treatment. Side effects, such as feeling tired, can limit the use of some of the medications.

Your doctor might suggest you try a nerve block, which is an injection with an anesthetic that will stop the nerve from hurting, at least for a little while.

If medicines do not help enough and the pain is affecting your ability to function, you may need surgery. During surgery, your doctor will damage or destroy certain nerves using chemicals, electric currents, radiation, or other means. The trigeminal nerve itself might be cut to eliminate or reduce the pain. Any surgery in which nerves are destroyed will cause some ongoing numbness. However, pain can sometimes return after surgery and be worse than before.


Living with trigeminal neuralgia

Not knowing when you’ll have flareups of facial pain is stressful. That’s why it is important to work with your doctor to find a treatment plan that will work for you. Also, become as knowledgeable about your condition as possible. That way, you can play a more active role in your care. Find a support group of other people who have trigeminal neuralgia. Having a safe space to vent and share stories can go a long way in boosting your mental and emotional health. It also reminds you that you aren’t alone.

Questions to ask your doctor

  • I have multiple sclerosis. Am I at risk of trigeminal neuralgia?
  • I’ve had trigeminal neuralgia. How can I prevent it from happening again?
  • How long will this condition last? Will it go away permanently?
  • Will I need surgery to treat trigeminal neuralgia?
  • Will lifestyle changes help treat or prevent trigeminal neuralgia?