Trigeminal Neuralgia

What is it?

It is a chronic pain condition that affects the nerve, which carries sensation from the face to the brain. The nerve is called trigeminal nerve. Even mild stimulation of the face can result in a jolt of excruciating pain. Women are more commonly affected. Usually seen in people more than 50 years of age.

What are the symptoms?

• Episodes of severe shooting or jabbing pain resembling electric shock
• Attacks triggered by touch, chewing, brushing or speaking
• Pain usually lasts for a few seconds to a minute
• Remissions and relapses
• Pain only in the area supplied by trigeminal nerve
• Mostly on one side of face
• Pain usually starts from one fixed spot
• Attacks become more frequent and intense over a period of time

What are the causes?

• The main cause is a conflict between the nerve and a blood vessel close to it. This contact puts pressure on the nerve causing it to malfunction
• Very rarely trauma and stroke
• Neurologic disorders like multiple sclerosis
• Very rarely tumor compressing the trigeminal nerve

What triggers the pain?

• Shaving
• Touching the face
• Eating and drinking
• Brushing the teeth
• Washing the face
• Smiling and talking

How do u diagnose?

• Detailed history and clinical examination
• MRI to see for the neurovascular conflict

How does one treat?

• Medications like anticonvulsants and muscle relaxants
• Botox injections
• Glycerol injection into the nerve at the base of the brain
• Balloon compression where a balloon is taken to the base of the brain and kept inflated to damage the nerve
• Radio frequency thermal lesioning where the nerve fibers are damaged with thermal energy
• Gamma knife focused radiation
• Surgery is called micro vascular decompression where the nerve and the vessel are separated by a piece of Teflon placed between them to keep them separated. This entails opening the skull.

Authored By Dr. Sai Sudarsan