Trigeminal Neuralgia Overview
Trigeminal neuralgia, is a headache condition that presents with pain on one side of the face, typically along the mid-to-lower face. The pain tends to feel superficial, sharp, piercing, stabbing, shooting, and short-lasting. The duration of the pain is typically seconds to a couple of minutes per episode, though some patients experience a more dull underlying pain in between the sharp pain attacks.
Trigeminal neuralgia can be classified as “classical,” “secondary,” or “idiopathic.” Classical trigeminal neuralgia occurs as a result of compression of the trigeminal nerve by a blood vessel. Secondary trigeminal neuralgia can occur as a consequence of a tumor, vascular malformation, or other brain lesion (e.g., multiple sclerosis) damaging or compressing the trigeminal nerve or its pathway in the brain. Finally, idiopathic trigeminal neuralgia is diagnosed when no cause is identified.
Trigeminal Neuralgia Symptoms
Trigeminal neuralgia is characterized by relatively brief episodes of pain on one side of the face. The pain tends to feel superficial, sharp, piercing, stabbing, shooting, and short-lasting. The duration of the pain is typically seconds to a couple of minutes per episode, though some patients experience a more dull underlying pain in between the sharp pain attacks. Typically, attacks stop for a period of time and then return, with fewer and shorter pain-free periods as the condition progresses. The location of the pain tends to be in the lower half of the face.
Experiencing facial pain does not necessarily mean you have trigeminal neuralgia, as many conditions can cause facial pain.
It is common for patients with trigeminal neuralgia to experience triggers related to skin contact, also known as cutaneous triggers, such as:
- Shaving your face
- Brushing your teeth
- Applying makeup
- Being exposed to wind
The attacks vary in severity, frequency, and duration, often becoming worse over time.
Trigeminal Neuralgia Treatments
Several options are available for the treatment of trigeminal neuralgia. The first choice, if appropriate, is typically carbamazepine or oxcarbazepine. These are antiepileptic medications, though they have also been shown to be effective in the management of trigeminal neuralgia. Other options include baclofen, lamotrigine, gabapentin, phenytoin, depakote (i.e., valproate), and pregabalin (i.e., Lyrica).
Options for refractory cases exist, as well, and are generally procedural or surgical in nature. The invasiveness of procedures varies significantly, and most options are considered to be “destructive” to the trigeminal nerve. Microvascular decompression is a nondestructive surgical treatment for trigeminal neuralgia which involves a craniotomy to allow a neurosurgeon to move a compressing blood vessel out of direct contact with the trigeminal nerve. Other forms of treatment, such as Gamma Knife surgery and radiofrequency thermoregulation (RFT) are considered destructive and can result in varying levels of numbness in the distribution of the trigeminal nerve. Gamma Knife radiosurgery can be used to treat trigeminal neuralgia without the need for an incision. In this procedure, beams of radiation are used to damage the trigeminal nerve, reducing or eliminating pain.
A trigeminal nerve block is a relatively safe and relatively noninvasive method of trying to treat trigeminal neuralgia pain, though the effectiveness of the procedure varies significantly from patient to patient with trigeminal neuralgia.
Sphenopalatine ganglion block can also be effective for treating trigeminal neuralgia.
How common is trigeminal neuralgia?
New cases of trigeminal neuralgia occur at a rate of approximately 12 per 100,000 people per year.
Who gets trigeminal neuralgia?
Trigeminal neuralgia can occur at any age, but is most likely to occur in people over 50. It is more common in women than in men.
Trigeminal neuralgia can be caused by damage to the trigeminal nerve’s protective coating, called the myelin sheath, as a result of multiple sclerosis or a blood vessel pressing on the nerve. Symptoms can also be caused by compression from a tumor or a large tangle of arteries and veins, called an arteriovenous malformation, but these causes are not common.
How is trigeminal neuralgia diagnosed?
Trigeminal neuralgia is mainly diagnosed based on your symptoms and medical history, along with the results from physical and neurological examinations. Magnetic resonance imaging (MRI) may be used to determine if a compressing blood vessel, tumor, or multiple sclerosis is the cause.