Trigeminal neuralgia (TN) is a disorder of the trigeminal nerve (fifth cranial nerve) that causes severe, shooting pain along one side of the face. The trigeminal nerve senses touch, pain, pressure, and temperature. It also helps make saliva and tears.
The Trigeminal Nerve
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In TN, pain usually lasts for less than a second to a few seconds and may come and go for days, weeks, months, or years. It may go into remission or stop completely for months or years. Over time, though, the attacks may become more frequent and more severe.
In most cases, the cause is unknown. In some cases it may be caused by an abnormally formed artery or vein near the nerve. The blood vessel can compress the nerve and cause problems. Rarely, TN may occur as a symptom of another underlying disorder, such as:
- Tumor in the brain or head
- Multiple sclerosis
The main symptom is searing pain on one side of the face. The pain may be felt inside the mouth or in the lips, cheek, chin, nostril, ear, or near the eye. Rarely, pain may occur in the eye or forehead. Twitching or wincing sometimes accompanies the pain.
The pain is typically sudden, severe, and stabbing. Even though the pain is brief, usually less than two minutes, it can reoccur hundreds of times a day. Attacks can become totally disabling. They may seem to occur at random or be triggered by extremes of temperature, washing, shaving, touching, or tickling the face. There are usually no symptoms between attacks, except perhaps a dull ache.
Your doctor will ask about your symptoms and medical history. A physical exam will be done. You may have an electrophysiologic test called a trigeminal reflex test. Other tests, such as a CT scan or MRI can take pictures of your internal body structures.
You may be given antiseizure medication to help diagnose the disorder.
Treatment usually begins with medicine. If medicine fails, other options are available.
Medicines may include:
- Other antiseizure medicines (eg, phenytoin, gabapentin, lamotrigine, oxcarbazepine, pregabalin, topiramate)
- Low-dose antidepressants (eg, amitriptyline, clomipramine)
- Muscle relaxer (eg, baclofen)
- Other medicines, such as sumatriptan (Imitrex) injection, lidocaine nasal spray
Surgical options include:
- Surgery to remove an artery or tumor that is pressing on the nerve
- Surgery to cut the trigeminal nerve
Surgery can be highly effective in some cases. The most common procedure is microvascular decompression.
These procedures may be somewhat less effective than microvascular surgical decompression. But, they are widely used, especially in older patients.
- Gamma Knife radiosurgery: For patients who can't get relief from medical therapy, good pain relief might be achieved with Gamma Knife radiosurgery. Find out more about Gamma Knife at UVA.
- Injections of alcohol or glycerin to deaden the nerve
- Injections of pain relievers or steroids to decrease inflammation/irritation of the nerve.
- High-frequency radio waves to deaden the nerve
There are no current guidelines to prevent TN.