Page Updated on Jan 31, 2020 by Dr. Reyfman (Pain Management Specialist) of Pain Physicians NY

Trigeminal neuralgia is a chronic pain disorder of the trigeminal nerve, which is responsible for the sensation of the face, the mucous membranes in the mouth and nose, and the cornea. It controls a large part of the chewing muscles.

Trigeminal Neuralgia | Best Brooklyn Chronic Pain DoctorsIf a patient has trigeminal neuralgia, the slightest touch on the face can lead to the most severe short-term pain attacks of seconds to a few minutes in one or more branches of the nerve.

Initially, the pain attacks are often only mild, but can quickly increase to the highest pain intensity, which leads to patients not eating anymore for fear of the attacks. The pain occurs periodically, which means that there are weeks and months without symptoms before a phase with frequent attacks occurs again. Typically, the disease occurs in older age, in those over the age of 50 and usually only on one side. Women are affected slightly more often than men.

Causes and Types of Trigeminal Neuralgia

According to current knowledge, the cause of pain in classical trigeminal neuralgia is a compression of a blood vessel in the area of ​​the exit of the trigeminal nerve at the brain stem. In rare cases, trigeminal neuralgia can also be the result of tumors, vascular malformations or multiple sclerosis. In the latter case in particular, younger people are often affected, sometimes on both sides.

Trigeminal neuralgia is a facial pain and must be separated from the different headaches such as tension headaches, migraines or the trigeminal autonomic headaches such as the cluster headache or the paroxysmal hemicrania continua.

There are certain forms of trigeminal neuralgia:

  • The classic trigeminal neuralgia which is purely paroxysmal with accompanying permanent pain,
  • Secondary trigeminal neuralgia which is caused by multiple sclerosis, tumors, vascular malformations, and other diseases,
  • Idiopathic trigeminal neuralgia which is purely paroxysmal and with accompanying permanent pain.

What facial pain must be distinguished from trigeminal neuralgia?

Pain caused by damage to the trigeminal nerve, like for example after operations on the teeth or paranasal sinuses, as well as pain after injuries should be distinguished from trigeminal neuralgia.

What are the treatment options for trigeminal neuralgia?

A basic distinction is made between 3 different treatment methods provided by Pain Physicians.

  • Percutaneous procedure – in this procedure, a nerve node at the base of the skull, the so-called ganglion gasseri is found with a cannula that is inserted next to the corner of the mouth. Then one tries to damage one or more branches of the trigeminal nerve in a controlled manner with a targeted heat lesion, thermocoagulation, or alcohol injection in order to prevent the development and transmission of pain. These procedures are routine neurosurgical interventions that have been used successfully in several thousand patients worldwide. Other procedures include balloon compression of the ganglion gasseri or ganglionic local opioid application.
  • Microvascular decompression of the trigeminal nerve – s done under general anesthesia. A 5-mark piece of bone fragment is sawn out through a cut behind the ear and the trigeminal nerve is then examined under the surgical microscope. If an artery appears that narrows or presses the nerve, it is carefully detached and a small piece of plastic is inserted between the vessel and nerve as a buffer.
  • Radiosurgery – targeted, usually one-time high-dose radiation with a special radiation device causes radiation damage of a few millimeters in diameter in the area of ​​the nerve path next to the brain stem. The effect starts after a few weeks and the advantage lies in the non-invasiveness of the method.

What should you do if you have trigeminal neuralgia?

See a neurologist or neurosurgeon because they are very familiar with the clinical picture. First, you will initiate drug therapy. In many cases, this treatment is sufficient. However, if pain persists at higher doses or the medication causes side effects, you should be introduced to a neurosurgeon who will talk to you about the various surgical options, their prospects and side effects. A magnetic resonance tomography is also routinely arranged there, with which one tries to visualize the compressing vessel and exclude rare causes of a tumor or an inflammatory disease.