Trigeminal neuralgia

Q: Potential treatment options

Medication : The mainstay of treatment is medical, using a range of drugs which have been found to give either complete or partial relief. This may include anticonvulsant medication to block the pain transmission in the nerve. Your doctor can talk to you about the variety of medication available. Surgery : If medication fails to control the pain, or the side effects are too great, there are surgical options including: Injections under general anaesthetic: A needle passed through the cheek and skull base into the trigeminal nerve using x-ray guidance Cryotherapy: Freezing of the the nerves, using a probe cooled by liquid nitrogen, as they emerge from the skull to supply the face. This procedure is normally performed by Oral surgeons. The pain is often relieved for a period, but usually recurs as the nerves recover from the damage. Microvascular decompression surgery: The most effective form of treatment. This is an operation to move an artery away from the trigeminal nerve. Although we are not certain that vascular compression causes neuralgia, the operation has a high chance of relieving pain long-term. Gamma Knife radiosurgery : Where a high dose of radiation is delivered to the trigeminal nerve by a radiation beam which targets the nerve and damage the trigeminal nerve pain fibres.

A chronic pain condition that affects the trigeminal nerve

An uncommon form of facial pain which typically gives rise to severe, intermittent sharp pain, often described as ‘stabbing’ or ‘electric-shocks’.

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What is trigeminal neuralgia?

Trigeminal neuralgia is a severe and sudden type of facial pain. It's believed to be caused by an artery or vein compressing your trigeminal nerve (the nerve that gives feeling to the face). Other causes include tumours compressing the nerve, and multiple sclerosis which causes loss of the ‘insulation’ around nerve fibres.

There are two trigeminal nerves, one for each side of the face. They are each formed of three branches which give feeling to the forehead, cheek and jaw respectively. Those diagnosed with neuralgia experience pain only on one side of the face, usually in the cheek and/or jaw, with fewer patients suffering pain in the forehead and eye.

The neuralgic pain is not constant, but comes in waves or spasms, sometimes lasting for minutes at a time before easing off. In between attacks the victim is normally pain-free but fearful of talking, eating or otherwise triggering the next spasm. These attacks can lead to anxiety as well as actual pain. To help this, we offer a range of treatment options to improve your condition.

Need to know

What are the symptoms of trigeminal neuralgia?

The main symptom of trigeminal neuralgia is a severe, sharp-shooting pain in your jaw, teeth and gums. In some cases, the pain may also be felt in the forehead or eye. These attacks can be very intense and occur regularly.

Actions or movement that can trigger these symptoms include:

talking
smiling/laughing
chewing/swallowing
brushing your teeth
touching your face
washing your face

How is trigeminal neuralgia diagnosed?

The severe pain you may feel from trigeminal neuralgia will help your consultant make a diagnosis. From their discussion with you, they will then likely undertake an MRI scan, to give a clear image of the trigeminal nerves.

An MRI scan can help your consultant to identify any abnormality around the nerve, particularly the proximity of an artery or the presence of a benign tumour in contact with the nerve.

Potential treatment options

Medication: The mainstay of treatment is medical, using a range of drugs which have been found to give either complete or partial relief. This may include anticonvulsant medication to block the pain transmission in the nerve. Your doctor can talk to you about the variety of medication available.

Surgery: If medication fails to control the pain, or the side effects are too great, there are surgical options including:

Injections under general anaesthetic: A needle passed through the cheek and skull base into the trigeminal nerve using x-ray guidance
Cryotherapy: Freezing of the the nerves, using a probe cooled by liquid nitrogen, as they emerge from the skull to supply the face. This procedure is normally performed by Oral surgeons. The pain is often relieved for a period, but usually recurs as the nerves recover from the damage.
Microvascular decompression surgery: The most effective form of treatment. This is an operation to move an artery away from the trigeminal nerve. Although we are not certain that vascular compression causes neuralgia, the operation has a high chance of relieving pain long-term.
Gamma Knife radiosurgery: Where a high dose of radiation is delivered to the trigeminal nerve by a radiation beam which targets the nerve and damage the trigeminal nerve pain fibres.