The trigeminal nerve is the largest cranial nerve. It allows for sensation in the face and controls the muscles moving the jaw. Trigeminal neuralgia is pain resulting from that nerve and is usually located on one side of the cheek or jaw.
Signs and Symptoms
Trigeminal neuralgia causes severe facial pain. Common symptoms include:
- Sharp, electric jolts of pain that last from a few seconds to a few minutes
- No pain or numbness between jolts
- Numbness or tingling before the jolts
- Pain only on one side of the face, between the hairline and the chin, or in the teeth
- Pain triggered by touching the face or teeth
The pain from trigeminal neuralgia is less likely to respond to treatment if it is constant, dull or aching, outside the face such as behind the ear or down the neck, on both sides of the face or accompanied with numbness.
Trigeminal neuralgia may be caused by the pressing of the trigeminal nerve by a blood vessel, wearing down the protective layer of the nerve and resulting in increased sensitivity.
Other conditions can cause the same symptoms, so it is important to check with your doctor for an accurate diagnosis. Only a doctor experienced in recognizing the exact combination of symptoms that indicate trigeminal neuralgia can make a firm diagnosis.
Diagnosis of trigeminal neuralgia starts with a physical exam and medical history. Other procedures and tests may be needed to diagnose this condition, including:
- Magnetic resonance imaging MRI scan uses powerful magnets to create detailed pictures of the internal tissues.
- Magnetic resonance angiography MRA scan is a type of MRI that creates an image of the nerves with powerful magnets.
- CT scan is an x-ray that shows the inside of the scanned section from different angles.
There are a few treatment options that can bring relief from trigeminal neuralgia pain:
- Pain management medications (non narcotic)
- Percutaneous procedures including glycerol injection and thermal or balloon rhizotomy. These procedures are only done for patients who have tried medication for pain without success. They are less likely to work in patients with atypical pain. After the patient is asleep, a tiny cut is made one inch to the side of the corner of the mouth. A needle is then passed through the wall of the check to the bottom of the skull. Using x-rays or CT scans, the needle is guided through a small opening in the skull into an area called Meckel’s cave, where the trigeminal nerve lives. At this point, a procedure is done to damage the nerve in a controlled fashion. This includes compressing the nerve with a balloon for a short period of time, burning the nerve with an electrode at high temperature, or burning the nerve with a chemical called glycerol. The most common procedure is the first: a balloon compression rhizotomy. This procedure allows the patient to remain fully asleep and takes only 5 – 10 minutes in most instances. The needle is then removed, and the patient returns home a few hours after waking up from anesthesia.
- Microvascular decompression surgery
- Radiosurgery. This procedure can gradually injure the pain fibers in the nerve that causes trigeminal neuralgia, relieving pain. It is a very precise form of radiation treatment. The abnormal area is outlined on a 3D image of your brain. Small beams of radiation are directed to the target from many different angles. Each beam has little effect on your normal brain tissue. However, a very high dose of radiation hits the target. It is the one spot where all the different beams intersect.