What is Trigeminal Neuralgia?
Trigeminal neuralgia (TN), also called tic douloureux, is a chronic pain condition that causes extreme, sporadic, sudden burning or shock-like face pain. The pain seldom lasts more than a few seconds or a minute or two per episode. The intensity of pain can be physically and mentally incapacitating. TN pain is typically felt on one side of the jaw or cheek. Episodes can last for days, weeks, or months at a time and then disappear for months or years. In the days before an episode begins, some patients may experience a tingling or numbing sensation or a somewhat constant and aching pain.
The attacks often worsen over time, with fewer and shorter pain-free periods before they recur. The intense flashes of pain can be triggered by vibration or contact with the cheek (such as when shaving, washing the face, or applying makeup), brushing teeth, eating, drinking, talking, or being exposed to the wind. TN occurs most often in people over age 50, but it can occur at any age, and is more common in women than in men. There is some evidence that the disorder runs in families, perhaps because of an inherited pattern of blood vessel formation. Although sometimes debilitating, the disorder is not life-threatening.
The presumed cause of TN is a blood vessel pressing on the trigeminal nerve in the head as it exits the brainstem. TN may be part of the normal aging process but in some cases it is the associated with another disorder, such as multiple sclerosis or other disorders characterized by damage to the myelin sheath that covers certain nerves.
Treatment Options:
- Medication - The first treatment considered for TN is medication, most often anticonvulsants such as carbamazepine, oxcarbazepine, topiramate, phenytoin, gabapentin and pregabalin.
- Surgery (Microvascular Decompression) - Neurosurgeons perform a microvascular decompression through a small incision behind the ear. The surgeon uses a microscope to assess the trigeminal nerve as it arises from the brain stem. Then he attempts to alleviate neurovascular compression upon the nerve root by using micro-instruments to move the blood vessels that are irritating the trigeminal nerve. This allows the nerve to recover and the patient to return to a normal, pain free condition. Recovery from this procedure is brief. Most patients can be discharged from the hospital one or two days after surgery.
- Glycerol Rhizotomy - Percutaneous glycerol rhizotomy is a minimally invasive alternative treatment for trigeminal neuralgia. It consists of a drop or two of glycerol injected through the patient's cheek around the trigeminal nerve at the skull base using a spinal needle. This operation is performed under local anesthesia with sedation in the operating room and is done as outpatient surgery.
- Stereotactic radiosurgery – This procedure uses narrow beams of radiation directed at the trigeminal nerve root causing a lesion to form over a period of time, thus interrupting the pain transmission. The NeuroTexas Institute currently utilizes GammaKnife technology.
Information from the National Institutes of Health, November 2008
