Trigeminal neuralgia (TN) is a chronic pain condition characterized by excruciating pain that affects the trigeminal nerve. The trigeminal nerve is composed of three large branches, the ophthalmic nerve (V1), maxillary nerve (V2), and mandibular nerve (V3). These nerves provide sensory innervation to the face and motor innervation to the muscles that are used for chewing and swallowing. It is estimated that 150,000 people are diagnosed with trigeminal neuralgia every year. A hallmark of TN is sudden, severe, and shock-like pain in the face, lasting from a few seconds to a couple of minutes. The pain is so severe at times that this condition is often referred to as “suicide disease” because of the significant impact on the quality of life.
What Causes Trigeminal Neuralgia?
Trigeminal neuralgia is usually caused by the compression of the trigeminal nerve causing the nerve to misfire. It can also result from damage and wearing away of the nerve’s protective myelin sheath. Multiple sclerosis (which also damages myelin), tumors, or facial trauma are also notable causes of trigeminal neuralgia. In some cases, no clear cause is identified. Women are more likely to have it than men and the risk increases over the age of 50. There is some evidence the disorder may be hereditary.
What are the Symptoms of Trigeminal Neuralgia?
There are two types of Trigeminal Neuralgia
- Typical or “classic” form of the disorder causes extreme, sporadic, and sudden burning or shock-like facial pain that lasts anywhere from a few seconds to a couple of minutes per episode. The attacks can occur in quick succession, or in episodes lasting a couple of hours.
- “Atypical” form of the disorder (Type 2 or TN2), is characterized by constant aching, burning, and stabbing pain of somewhat lower intensity than Type 1.
Trigeminal neuralgia symptoms may include one or more of these patterns:
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A brief, spasm-like period of severe, shooting or jabbing pain that may feel like an electric shock.
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The pain can become a constant aching or burning feeling that’s less intense than the spasm-like pain.
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The pain is localized mostly in the cheek, jaw, teeth, gums, and lips.
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Pain affecting one side of the face at a time; however, it can affect both sides of the face.
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Pain lasting anywhere from a few seconds to several minutes.
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The attacks may happen several times a day or a week, followed by pain-free periods.
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The frequency of attacks often increases over time, and the pain becomes worse.
What are Triggers of Trigeminal Neuralgia?
What are the Treatment Options for Trigeminal Neuralgia?
Treatment for TN aims to alleviate pain and improve the patient’s quality of life. The options range from medications to surgical procedures, depending on the severity of the condition and the patient’s overall health.
1. Medications:
– Anticonvulsants: These are the first line of treatment and include drugs such as carbamazepine and oxcarbazepine. They work by stabilizing the nerve’s electrical activity.
– Muscle Relaxants: Baclofen is used in conjunction with anticonvulsants to reduce pain.
– Tricyclic Antidepressants: Drugs such as amitriptyline can help manage chronic pain by altering the way the brain processes pain signals.
2. Non-Pharmacological Treatments:
Peripheral Nerve Blocks and Ablation: Trigeminal nerve or Gasserian ganglion block has shown to have excellent outcomes for trigeminal neuralgia that is resistant to traditional medical treatments. This minimally invasive outpatient procedure involves using local anesthetic and other chemicals to block pain signals temporarily or permanently.
– Radiofrequency Rhizotomy: This minimally invasive procedure involves using heat generated by radio waves to selectively damage nerve fibers, reducing pain signals.
– Stereotactic Radiosurgery (Gamma Knife): A non-invasive procedure that delivers focused radiation to the trigeminal nerve root, causing gradual damage to reduce pain transmission.
– Balloon Compression: A balloon is inflated near the nerve root to compress it and relieve pain.
Data has shown that trigeminal nerve ablation has the highest rate of complete relief compared to other ablative techniques such as Gamma Knife surgery, Balloon compression, or Radiofrequency Rhizotomy. In fact, initial relief is achieved in 98% of patients with recurrence of pain at 12 months from 15-20% of patients.
Trigeminal neuralgia is a debilitating condition that requires a tailored approach to treatment. Patients should work closely with their healthcare providers to develop a comprehensive treatment plan that addresses their specific needs and circumstances. If you would like more information about trigeminal neuralgia or management of other acute or chronic pain conditions, please contact us at 704-317-1440 for a consultation with Dr. Manvar.