More on Trigeminal Neuralgia

We have all had experience with pain, and know that it can take on many different forms and affect any portion of our body. Our faces are no exception to this; facial pain, or trigeminal neuralgia, is a chronic condition that is estimated to affect about 15,000 Americans each year. And, while women and people over the age of 50 are more likely to experience this pain, trigeminal neuralgia can affect anyone.

Trigeminal Neuralgia occurs when any of the three trigeminal nerve branches within our face become in some way damaged. Each trigeminal nerve controls the feelings for different parts of our face. The ophthalmic branch affects our eye and forehead area; the maxillary branch controls the middle portion of our faces, including cheeks, nostrils, and upper lip; while the mandibular branch is responsible for our lower lip, lower gum, and jaw muscles. Often, patients with facial pain report a painful sensation in an isolated portion of their face, which is due to these differentiated nerve branches.

But what causes trigeminal nerve damage in the first place? There are several things that can lead to the onset of facial pain. Usually, the pain occurs when the myelin sheath-a type of coating around the nerve-is damaged in some way. This typically occurs when excess pressure is placed upon it by a blood vessel or tumor, but diseases such as multiple sclerosis can also damage it. In other cases, facial pain may be prompted by a stroke, some sort of facial trauma, or brain abnormalities.

Generally, it is quite easy to recognize facial pain, due to its distinctive symptoms and isolated location. Patients with trigeminal neuralgia typically report short periods of intense, shooting or shock-like pain, which is typically triggered by a certain action, such as brushing teeth, speaking, or shaving. These are the symptoms of “classical” trigeminal neuralgia; however, “atypical” trigeminal neuralgia is classified by a duller but constant aching or burning feeling. Usually facial pain occurs on one side of the face, but in rare cases both sides can be affected in what is called bilateral trigeminal neuralgia.

If any of these symptoms seem recognizable to you, it is a good idea to consult with your doctor immediately for a proper diagnosis. When it comes to diagnosing trigeminal neuralgia, your doctor will ask a number of questions regarding the origin of the pain and what typically triggers it. A neurological exam, in which various parts of the face are touched or examined to determine precisely the location of the pain, is also a common procedure. Sometimes, MRI scans are used to determine whether there is an underlying cause to the facial pain, such as a tumor or multiple sclerosis.

The most typical treatment options for trigeminal neuralgia are either medication or surgery. Anticonvulsants or muscle relaxants are the most commonly prescribed drugs to lessen facial pain. These medicines work by blocking the nerve signals that send pain messages to the brain, thereby lessening the painful sensations that the patient feels.

In some cases, surgery is a better option. Surgery is usually used to either damage the nerve itself so that it can no longer malfunction, or to remove the source of what is compressing the nerve and therefore causing the symptoms of pain. Some of the most common of these types of procedures are microvascular decompression and gamma knife radiosurgery. In microvascular decompression, arteries that are in contact with the nerve are relocated, or veins compressing it are removed through a small incision behind the ear. In radiosurgery, a small dosage of radiation is directed at the root of the trigeminal nerve so that it is damaged and the pain is reduced or eliminated. While after microvascular decompression pain may eventually return, results are usually permanent for gamma knife radiosurgery, which can also be repeated multiple times if symptoms persist. In addition to these procedures, different types of rhizotomy procedures may be effective, in which nerve fibers are destroyed to cause targeted facial numbness and lessen the perception of the pain.

No matter what procedure is used, there are numerous options available for those who are suffering from trigeminal neuralgia. If you believe you may be experiencing facial pain, consult your doctor for aid and treatment options.

Allison Karantzis