Trigeminal Neuralgia
Trigeminal neuralgia, or TN, is a chronic nerve pain that affects one of the most sensitive nerves in the head – the trigeminal (5th) cranial nerve.
Pain may affect a small area of your face or may spread, but it is almost always on one side only.
Intense flashes or shocks of pain can be triggered by contact with the cheek during routine activities like shaving, washing your face, applying makeup, brushing your teeth, eating, drinking or talking. Even exposure to the wind can trigger TN pain.
Symptoms rarely occur at night, when you are sleeping.
At the University of Maryland Medical Center, our team or neurologists, neurosurgery and neuroradiologists are experts at diagnosing and treating this rare condition. We want to help you return to a normal, pain-free life. Call 410-328-6034 to make an appointment.
Types of Face Pain
You can have both forms of TN. Sometimes they occur at the same time. The pain intensity can be physically and mentally incapacitating.
- Classic TN is the most common. Symptoms are sudden extreme burning or shock-like facial pain that lasts from a few seconds up to minutes. These sporadic episodes can come in quick succession, with some lasting up hours. The pain intensity can be physically and mentally incapacitating.
- Atypical facial pain is less common. Symptoms include a constant aching, burning, stabbing pain, not as intense as that in classic TN.
Conditions that can cause TN include:
- A blood vessel pressing on the trigeminal nerve near the brain stem
- Multiple sclerosis, which causes deterioration of the trigeminal nerve’s outer sheath
- Tumor compressing the nerve
- Arteriovenous malformation, a tangle of arteries and veins
Typically, TN episodes stop for a period and return. TN can be progressive, with fewer and shorter pain-free periods before they come back.
Trigeminal neuralgia is not fatal but can be debilitating. The pain intensity may cause some individuals to avoid daily activities or social contacts, for fear of an impending episode.
Who Gets TN
Trigeminal neuralgia is more common in women than in men, with about 12 new diagnoses a year for every 100,000 people. Although TN most often affects people over age 50, it can occur at any age. Young adults with multiple sclerosis are at increased risk for TN.
Diagnosing Trigeminal Neuralgia
Neurologists at University of Maryland Medical Center diagnose TN by reviewing your medical and family history, and by doing physical and neurological exams to rule out other disorders that cause facial pain. These include nerve pain from shingles, cluster headaches and temporomandibular joint disorder (TMJ), which causes pain and dysfunction in the jaw joint and muscles.
You may also have an MRI (magnetic resonance imaging) to make sure there is no tumor, arteriovenous malformation (AVM) or multiple sclerosis. MRI scans can also reveal a blood vessel pressing on the trigeminal nerve in classic TN. Positive effects of an antiseizure medication can help confirm whether you have TN.
Diagnosing atypical facial pain is more complex and treatment is more difficult. It may respond to low doses of certain antidepressant medications, which is similar to other types of neuropathic pain.
Trigeminal Neuralgia Treatments
Treatment options for TN include medication, surgery and complementary therapies.
Medication
Anticonvulsant medicines that block nerve function usually treat TN effectively. They are less effective for atypical facial pain. Certain antidepressants can also be effective for TN, but common pain relievers and opioids are typically not effective in reducing the sharp, recurring pain.
Trigeminal neuralgia is a progressive condition that can become resistant to medication. Some people experience side effects from medication such as memory loss, excess fatigue and bone marrow loss.
Surgery
Neurosurgical procedures for TN can be highly effective. Treatments off at the University of Maryland Medical Center include:
Gamma Knife (Stereotactic Radiosurgery)
A tightly focused beam of radiation is directed to where the trigeminal nerve exits the brain stem. This causes scarring of the nerve that blocks sensory signals to the brain. Most people don’t experience pain relief for several weeks or even months afterward. For about half of patients, some symptoms may return in later years.
Microvascular Decompression
MVD is an invasive of all TN surgeries, but it offers the best chance that pain will not return. Our neurosurgeons put a small cushion between the trigeminal nerve and the blood vessel compressing the nerve.
The goal of MVD is to remove pain while leaving normal facial sensation intact. Recovery usually takes several weeks. About half of patients who have MVD for TN will have recurrent pain in later years.
Other Options
Other procedures that have been used in the past for TN – like rhizotomy, glycerol injections and radiofrequency thermal lesioning – are not offered at the University of Maryland because they have limited efficacy, they may damage the trigeminal nerve, and in some cases they may predispose to atypical facial pain (anesthesia dolorosa).
Complementary Therapies
Some people manage trigeminal neuralgia using complementary techniques, usually in combination with drug treatment, with varying degrees of success. Complementary therapies include:
- Acupuncture for nonsurgical pain relief
- Biofeedback to control physical functions
- Botox® to block activity of sensory nerves
Living with TN
Chronic trigeminal neuralgia pain can often be isolating and depressing. Some people benefit from supportive counseling or psychological therapy. However, there is no evidence that TN is psychogenic in origin or caused by depression. People with TN require effective medical or surgical treatment for their pain.
Make an Appointment
Make an appointment with one of our neurosurgeons. Call 410-328-6034.