FAQs on Trigeminal Neuralgia Answered by the Top Pain Center in Phoenix

Trigeminal neuralgia (TN), also called tic douloureux, is described as one of the most painful condition known to man. This condition is caused by irrigation to the trigeminal nerve. The pain usually involves the jaw and lower face, but it can affect the area above the eye and around the nose.

What is the trigeminal nerve?

Twelve pair of cranial nerves branch off the brain. The trigeminal nerve is the fifth pair of cranial nerves. One of the trigeminal nerves runs to the right side of the head, and the other one goes to the left. These nerves have three distinct branches. The trigeminal nerve comes off the brain and travels inside the skull, where it divides into three smaller branches. The first branch controls eye and forehead sensation, the second one controls sensation to the cheek, nostril, upper gum, and upper lip, and the third one innervates the lower gum, lower lip, jaw, and chewing muscles.

How common is trigeminal neuralgia?

Trigeminal neuralgia affects around 150,000 people each year. This disorder can occur at any age, but it is more common among persons over the age of 50 years. The National Institute of Neurological Disorders and Stroke report that TN affects women more often than men.

What are the risk factors for TN?

Risk factors include:

Family history

Multiple sclerosis

Hypertension

What are the symptoms associated with trigeminal neuralgia?

Trigeminal neuralgia causes an intense, electric shock pain that is described as stabbing, severe, and excruciating. The onset of TN is reported to be sudden, with patients reporting it starts “out of nowhere.” Some patients report the pain following a blow to the face, car accident, or dental surgery. Classic TN pain has episodes of remission, whereas atypical pain is burning, constant, and affects a larger area of the face. This pain has no remission and is described as continuous.

What triggers attacks of trigeminal neuralgia?

The pain of TN is known to come and go. Attacks of trigeminal neuralgia are triggered by:

Shaving

Lightly touching the face

Washing

Brushing teeth

Blowing the nose

Smiling

Talking

Applying makeup

What are the causes of trigeminal neuralgia?

Trigeminal neuralgia is associated with irritation of the trigeminal nerve. The pain is cause by contact between a healthy vein or artery and the trigeminal nerve. This causes pressure on the nerve as it enters the brain, which makes the nerve send pain signals inappropriately. Other causes of TN include a tumor pressing on the nerve and damage to the myelin sheaths (nerve structures) due to multiple sclerosis.

How is trigeminal neuralgia diagnosed?

The doctor will ask many questions concerning your symptoms, and he/she will conduct a physical examination. To detect a tumor or multiple sclerosis, the doctor may order a magnetic resonance imaging (MRI) scan. Other tests will be ordered to rule out causes of facial pain.

How is trigeminal neuralgia treated?

The treatment of TN focuses on alleviating the symptoms of the condition. Options include:

 

Medications – Carbamazepine and phenytoin are anticonvulsant agents that control TN pain. However, a newer medication (oxcarbazepine) is now first-line treatment. In addition, the doctor may prescribe a muscle relaxant, such as Baclofen or Robaxin. Opioid analgesics are used for severe pain.

 

Percutaneous stereotactic rhizotomy – This is a procedure where the doctor uses electrocoagulation (heat) to destroy a portion of the trigeminal nerve root. The heat is introduced through a special needle passed through the cheek.

 

Percutaneous glycerol rhizotomy – With this procedure, glycerol is injected onto the nerve as it divides into the three main branches. The purpose of this is to damage the nerve and interfere with pain signal transmission.

 

Trigeminal nerve block – The doctor can insert a small needle through the cheek and instill a long-acting anesthetic or a neurolytic agent onto the nerve. This provides long-term pain relief.

 

Microvascular decompression – This is a major surgical procedure that is used for patients who do not respond to other therapies or who have debilitating pain. According to clinical studies, this procedure has a 90% success rate.

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