Trigeminal Neuralgia (TN) is a chronic pain disorder affecting the trigeminal nerve — the main sensory nerve of the face. It causes sudden, severe, electric-shock-like facial pain that can be triggered by speaking, chewing, brushing teeth, or even light touch. Attacks are brief but intensely painful, significantly affecting quality of life. Modern neurosurgical and interventional techniques offer effective, long-term relief for most patients.
Anatomy & Cause
The trigeminal nerve (cranial nerve V) has three branches:
- Ophthalmic (V1): forehead and eye region
- Maxillary (V2): cheek and upper jaw
- Mandibular (V3): lower jaw and chin
Primary (Classic) Trigeminal Neuralgia: Most cases are caused by a blood vessel (usually an artery) pressing on the trigeminal nerve near its brainstem entry zone, damaging its protective myelin and generating abnormal pain signals.
Secondary Trigeminal Neuralgia: Causes may include:
- Multiple sclerosis (MS)
- Tumors compressing the nerve
- Vascular malformations or aneurysms
- Facial trauma or dental procedures
Symptoms
- Sharp, stabbing, or electric-shock pain on one side of the face
- Pain lasting seconds to minutes, with symptom-free intervals
- Triggered by touch, talking, chewing, or cold air
- May affect one or multiple nerve branches
- Advanced cases: more frequent attacks, longer duration, background aching between shocks
Unlike tooth or sinus pain, trigeminal neuralgia pain is paroxysmal — it comes and goes abruptly.
Diagnosis
Diagnosis is primarily clinical and supported by imaging:
- Neurological Examination: Identifies pain distribution and rules out sensory loss or weakness suggesting secondary causes.
- MRI with Tractography / MR Angiography (MRA): Detects vascular compression, MS plaques, or tumors/cysts affecting the nerve.
- High-resolution MRI (CISS/FIESTA sequences) provides detailed visualization of nerve-vessel contact if unclear.
Treatment Options
1. Medical Therapy (First-Line)
- Carbamazepine (Tegretol) — gold standard
- Oxcarbazepine, Gabapentin, or Pregabalin as alternatives
If medications lose effectiveness or cause side effects, surgical options are considered.
2. Microvascular Decompression (MVD)
- Microsurgical procedure under general anesthesia.
- Small incision behind the ear; compressing vessel is moved away and Teflon pad placed between nerve and vessel.
- Nerve is preserved; long-term relief with ~85–90% immediate success.
Ideal for younger, healthy patients with MRI-confirmed vascular compression.
3. Percutaneous Rhizotomy Procedures
- Minimally invasive, via cheek under fluoroscopic or CT guidance.
- Options: Radiofrequency rhizotomy, Glycerol rhizotomy, Balloon compression
- Provide short-term relief (80–90%), especially in older or medically fragile patients.
4. Stereotactic Radiosurgery (Gamma Knife / LINAC)
- Non-invasive, uses focused radiation beams to target trigeminal root.
- Pain relief develops over 4–8 weeks.
- Suitable for patients unsuitable for open surgery or with recurrent pain.
5. Peripheral Nerve Branch Decompression or Ablation
- Targeted microdecompression or ablation for localized pain in branches such as supraorbital, infraorbital, or mental nerves.
Recovery & Follow-Up
- Medication adjustment often needed after procedures.
- Resume normal activities within a few days to 1 week.
- Follow-up MRI may be recommended after MVD.
- Repeat procedures or alternative techniques can be effective if pain recurs.
Proper treatment allows the majority of patients to achieve long-term pain control and improved quality of life.
Prognosis
- Medication-responsive TN: good control with minimal progression.
- Post-surgical TN: ~80–90% immediate relief; some recurrence after several years.
- Multiple sclerosis–related TN: may require combined medical and surgical management.
Modern techniques make complete, lasting relief achievable in most patients.
Patient Advisory
Trigeminal neuralgia is highly treatable but requires accurate diagnosis and individualized management. Each patient’s anatomy and pain pattern are unique — surgical timing and method must be determined by an experienced neurosurgeon. Do not delay consultation if you experience sudden, electric-shock facial pain — early treatment can prevent chronic nerve sensitization. Do not rely solely on online information to choose treatment.