Conditions We Treat
Trigeminal Neuralgia
What Is It?
Trigeminal neuralgia is a chronic pain condition that affects the trigeminal nerve, which provides sensation to the face. It causes sudden, severe, electric shock-like facial pain that is typically unilateral (one side of the face) and can be triggered by even mild stimulation.
The condition most often occurs when the trigeminal nerve is compressed, irritated, or damaged — commonly by a nearby blood vessel. In some cases it can be associated with multiple sclerosis, tumors, or nerve injury. Many cases are classified as idiopathic (no identifiable cause).
Symptoms
- Sudden, intense, stabbing or electric-shock-like pain in the face
- Pain usually affects the cheek, jaw, teeth, gums, or lips, and less commonly the eye or forehead
- Pain episodes last seconds to minutes, but may recur in clusters
- Pain triggered by touching the face, chewing, brushing teeth, talking, or even wind
- Unilateral symptoms (usually only one side of the face)
- Periods of remission may occur, but symptoms often return and worsen over time
Diagnosis
- Clinical history and symptom pattern are most important
- Sudden, brief, sharp attacks with known triggers are characteristic
- Neurological exam to rule out sensory deficits or other cranial nerve involvement
- MRI of the brain may be ordered to rule out structural causes (e.g., vascular compression, tumor, multiple sclerosis)
- Rarely, additional testing like MR angiography may help visualize blood vessels near the nerve
Treatment
Medical Management:
- Anticonvulsant medications are first-line:
- Carbamazepine (Tegretol) – most commonly prescribed
- Oxcarbazepine, gabapentin, baclofen, or lamotrigine may also be used
- Tricyclic antidepressants (e.g., amitriptyline) may help in some cases
Interventional Treatments:
- Nerve blocks (trigeminal nerve or its branches) using local anesthetics and steroids
- Radiofrequency ablation or glycerol injection to disrupt pain transmission
- Botox injections: an emerging option for some patients
Surgical Options:
- Microvascular decompression (MVD): relieves pressure from a blood vessel compressing the nerve — often effective in classic cases
- Gamma Knife radiosurgery: a non-invasive procedure that targets the nerve root with focused radiation
- Rhizotomy: surgically damaging part of the nerve to block pain signals — typically reserved for severe, treatment-resistant cases
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