Learn About Trigeminal Neuralgia

What is the definition of Trigeminal Neuralgia?

Trigeminal neuralgia (TN) is a nerve disorder. It causes a stabbing or electric shock-like pain in parts of the face.

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What are the alternative names for Trigeminal Neuralgia?

Tic douloureux; Cranial neuralgia; Facial pain - trigeminal; Facial neuralgia; Trifacial neuralgia; Chronic pain - trigeminal; Microvascular decompression - trigeminal

What are the causes of Trigeminal Neuralgia?

The pain of TN comes from the trigeminal nerve. This nerve carries the sensations of touch and pain from the face, eyes, sinuses, and mouth to the brain.

Trigeminal neuralgia may be caused by:

  • Multiple sclerosis (MS) or other diseases that damage the protective covering myelin of the nerves
  • Pressure on the trigeminal nerve from a swollen blood vessel or tumor
  • Injury to the trigeminal nerve, such as from trauma to the face or from oral or sinus surgery

Often, no exact cause is found. TN usually affects adults above age 50 years, but it can occur at any age. Women are affected more often than men. When TN affects people younger than 40, it is often due to MS or a tumor.

What are the symptoms of Trigeminal Neuralgia?

Symptoms may include any of the following:

  • Very painful, sharp electric-like spasms that usually last from several seconds to less than 2 minutes, but can become constant.
  • Pain is usually only on one side of the face, often around the eye, cheek, and lower part of the face.
  • There is usually no loss of sensation or movement of the affected part of the face.
  • Pain may be triggered by touch or sounds.

Painful attacks of trigeminal neuralgia can be triggered by common, everyday activities, such as:

  • Talking
  • Smiling
  • Brushing teeth
  • Chewing
  • Drinking
  • Eating
  • Exposure to hot or cold temperature
  • Touching the face
  • Shaving
  • Wind
  • Applying make-up

The right side of the face is mostly affected. In some cases, TN goes away on its own.

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What are the current treatments for Trigeminal Neuralgia?

Your primary care doctor, a neurologist, or a pain specialist may be involved in your care.

Certain medicines sometimes help reduce pain and the rate of attacks. These medicines include:

  • Anti-seizure medicines, such as carbamazepine
  • Muscle relaxants, such as baclofen
  • Tricyclic antidepressants

Short-term pain relief occurs through surgery, but is associated with risk of complications. One surgery is called microvascular decompression (MVD) or the Jannetta procedure. During surgery, a sponge-like material is placed between the nerve and the blood vessel that is pressing on the nerve.

Trigeminal nerve block (injection) with local anesthetic and steroid is an excellent treatment option to rapidly relieve pain while waiting for medicines to take effect.

Other techniques involve destroying or cutting parts of the trigeminal nerve root. Methods used include:

  • Radiofrequency ablation (uses high-frequency heat)
  • Injection of glycerol or alcohol
  • Balloon microcompression
  • Radiosurgery (uses high power energy)

If a tumor is the cause of TN, surgery is done to remove it.

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What is the outlook (prognosis) for Trigeminal Neuralgia?

How well you do depends on the cause of the problem. If there is no disease causing the problem, treatment can provide some relief.

In some people, the pain becomes constant and severe.

What are the possible complications of Trigeminal Neuralgia?

Complications may include:

  • Side effects of medicines used to treat TN
  • Problems caused by procedures, such as loss of feeling in the treated area
  • Weight loss from not eating to avoid triggering pain
  • Avoiding other people if talking triggers pain
  • Depression, suicide
  • High levels of anxiety during acute attacks
When should I contact a medical professional for Trigeminal Neuralgia?

Contact your health care provider if you have symptoms of TN, or your TN symptoms get worse.

Central nervous system and peripheral nervous system
What are the latest Trigeminal Neuralgia Clinical Trials?
Pathophysiological Mechanisms of Trigeminal Neuralgia - Neurophysiological Assessment of the Blink-reflex
Summary: This study aims to increase the understanding of the pathophysiology of trigeminal neuralgia by investigating the potential association between blink reflex abnormalities and phenotypical traits e.g. clinical characteristics and neuroimaging findings.
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BHV3000-202: Phase 2: A Double-Blind, Placebo Controlled, Crossover Trial of BHV-3000 (Rimegepant) for Treatment Refractory Trigeminal Neuraligia
Summary: The purpose of this study is to evaluate the efficacy of BHV3000 compared to placebo for subjects with treatment refractory Trigeminal Neuralgia as measured by a 2-point or greater reduction in the average Numeric Pain Rating Scale between the two-week treatment phases.
What are the Latest Advances for Trigeminal Neuralgia?
Surgical treatment of trigeminal neuralgia in adults.
Summary: Surgical treatment of trigeminal neuralgia in adults.
Efficacy, Safety, and Predictors of Response to Pulsed Radiofrequency Therapy for Acute Zoster-Related Trigeminal Neuralgia Patients: A Multicenter Retrospective Study.
Summary: Efficacy, Safety, and Predictors of Response to Pulsed Radiofrequency Therapy for Acute Zoster-Related Trigeminal Neuralgia Patients: A Multicenter Retrospective Study.
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The management of trigeminal neuralgia with triptans, a narrative review of the literature.
Summary: The management of trigeminal neuralgia with triptans, a narrative review of the literature.
Who are the sources who wrote this article ?

Published Date: June 23, 2020
Published By: Amit M. Shelat, DO, FACP, FAAN, Attending Neurologist and Assistant Professor of Clinical Neurology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

What are the references for this article ?

Bendtsen L, Zakrzewska JM, Heinskou TB, et al. Advances in diagnosis, classification, pathophysiology, and management of trigeminal neuralgia. Lancet Neurol. 2020;19(9):784-796. PMID: 32822636 pubmed.ncbi.nlm.nih.gov/32822636/.

Gonzales TS. Facial pain and neuromuscular diseases. In: Neville BW, Damm DD, Allen CM, Chi AC, eds. Oral and Maxillofacial Pathology. 4th ed. St Louis, MO: Elsevier; 2016:chap 18.

Stettler BA. Brain and cranial nerve disorders. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 95.

Waldman SD. Trigeminal neuralgia. In: Waldman SD, ed. Atlas of Common Pain Syndromes. 4th ed. Philadelphia, PA: Elsevier; 2020:chap 10.