Trigeminal neuralgia

Trigeminal Neuralgia (TN) is a chronic condition that causes sudden and severe facial pain. Also referred to as tic douloureux, TN is usually caused by an underlying medical issue. Your doctor can help you identify the root causes of your TN and help to relieve your symptoms.

While trigeminal neuralgia usually occurs in people over the age of 50, it can affect all age groups, including babies. If you are experiencing TN, it’s important to know you’re not alone and there is help available. Although it can be challenging and disruptive, TN can usually be treated or managed through medication, surgery, occupational therapy, and other methods to help you live pain free or as comfortably as possible.   

Trigeminal neuralgia symptoms vary according to the location of nerve pressure and the type of TN you’re experiencing. Some of the main symptoms include:    

• Sudden intense pain in a centralized area of the face or head
• Numbness, tingling, or burning in the affected area
• Pain episodes that last for a few seconds, stop and then start up again
• Throbbing or burning pain in the face and head   

Episodes can last for days or weeks and occur multiple times per day. Pain often occurs in the eyes, lips, jaws, nose, scalp, forehead, and area behind the ears. 

While the exact cause of trigeminal neuralgia is unknown, TN impacts the trigeminal nerve (also known as the fifth cranial nerve) that carries sensory information to multiple areas of the head and face. It occurs when pressure is placed on one or more of the trigeminal nerves. This compression usually occurs at the brainstem (the area of the head where the brain meets the spinal cord). The trigeminal nerves are a group of 12 cranial nerves connecting your brain and brainstem to the head, torso, and neck. While TN can occur on its own, it’s also associated with a variety of underlying health conditions, including but not limited to:    

• Multiple sclerosis (MS)
• Facial or dental trauma/injury
• Facial tumor or cyst
• Arteriovenous malformation (tangling or bunching of arteries and veins)
• Stroke
• Oral cancer

TN can also occur by pressure from blood vessels on the trigeminal nerve that can cause breakdown of its protective layering also known as the myelin sheath.

Diagnosing TN starts with a full medical history exam and may include a variety of neurological tests. These often include magnetic resonance imaging (MRI) or computerized tomography (CT) of the head to rule out underlying conditions such as a brain tumor, stroke, or MS. During your exam, your primary care physician or neurologist will ask about how long, where, and how much you’re experiencing facial pain to get to its root cause. 

Treatment for trigeminal neuralgia depends on a variety of factors, including the severity and frequency of pain and additional health issues. Primary treatments include:

• Medications: Anticonvulsants can help prevent spontaneous nerve activity but are more effective in typical TN than atypical. Over-the-counter pain relievers and prescription opioids are more effective in treating pain from atypical TN. Antidepressants can also help to relieve pain in both types of trigeminal neuralgia.
• Surgery: Rhizotomy procedures are used to selectively cut affected nerve roots to the spinal cord. These include balloon compression, glycerol injections, radiofrequency thermal lesioning, and stereotactic radiosurgery to help deaden the affected nerves and block pain. Microvascular decompression helps relieve pressure on the impacted nerve but is the most invasive type of procedure for TN. Your doctor can help you decide if this procedure is right for you.

Chiropractic care, acupuncture, biofeedback, nutritional counseling, and vitamin therapy may also help relieve facial pain from trigeminal neuralgia, along with botulinum toxin (Botox) injections to prevent sensory nerve activity. You may also benefit from everyday holistic activities, such as low-impact exercise, meditation, yoga, and mindfulness exercises.