Definition

Trigeminal neuralgia (TN) is a disorder of the trigeminal nerve (fifth cranial nerve) that causes severe, shooting pain along one side of the face. It senses touch, pain, pressure, and temperature. It also helps make saliva and tears.

The Trigeminal Nerve

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In trigeminal neuralgia, pain usually lasts for a few seconds and may come and go for days, weeks, or months. It may go into remission or stop completely for months or years. Over time, though, the attacks usually become more frequent and more severe. Attacks can be brought on by chewing, washing, shaving, touching, or even a breeze on the face.

Causes

In most cases of trigeminal neuralgia the cause is unknown. Sometimes an abnormally formed artery or vein running too close to the nerve and compressing it proves to be the culprit. Rarely, TN may occur as a symptom of another underlying disorder, such as:

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors for trigeminal neuralgia include:

  • Age: 50 or older
  • Sex: female (a slightly higher risk)

Symptoms

The main symptom is searing pain on one side of the face. The pain may be felt inside the mouth or in the lips, cheek, chin, nostril, ear, or near the eye. Rarely, pain may occur in the eye or forehead. Twitching or wincing sometimes accompanies the pain.

The pain is typically sudden, severe, and stabbing. Even though the pain is often brief (less than two minutes) it can reoccur hundreds of times per day. Attacks, which can become totally disabling, may seem to occur at random or be triggered by extremes of temperature, washing, shaving, touching, or tickling the face. There are usually no symptoms between attacks, except perhaps a dull ache.

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam.

Tests may be performed to help diagnosis underlying conditions that may lead to TN. These may include:

  • CT scan—a type of x-ray that uses a computer to make pictures of structures inside the head
  • MRI scan—a test that uses magnetic waves to make pictures of structures inside the head

You may be given the antiseizure medication carbamazepine. In many patients, carbamazepine effectively reduces the pain and is sometimes used to help diagnose the disorder.

Treatment

Treatment usually begins with medication. If medication fails, other options are available.

Medications

Medications may include:

  • Carbamazepine
  • Other antiseizure medications: phenytoin, gabapentin, lamotrigine, oxcarbazepine, and topiramate
  • Low-dose antidepressants (such as amitryptiline and clomipramine)
  • Baclofen

Other helpful medications include single doses of sumatriptan (Imitrex) given subcutaneously (injection beneath the skin) and lidocaine 8% as a nasal spray. In two separate, recent clinical trials involving roughly 25 patients each, sumatriptan and lidocaine effectively relieved trigeminal pain for an average of 8 and 4.3 hours, respectively. There is no evidence that repeated doses of these medications would be beneficial. *

Antiseizure medications are often the most helpful in treating TN.

Analgesics such as aspirin an ibuprofen are often not effective in TN.

Surgery

Surgical options include:

  • Surgery to remove an artery or tumor that is pressing on the nerve
  • Surgery to cut the trigeminal nerve

Surgery can be highly effective in selected patients. The most common surgical procedure in current use is probably microvascular decompression. As with many surgical procedures, complications are fewer when surgery is performed in hospitals (and by surgeons) serving relatively high volumes of patients with trigeminal neuralgia.

Other Treatments

Other options to deaden the trigeminal nerve include:

  • Stereotactic radiosurgery (also known as Gamma Knife™, CyberKnife® , LINAC, as well as by other names)
  • Injections of alcohol or glycerin to deaden the nerve
  • High-frequency radio waves to deaden the nerve

These procedures may be somewhat less effective than microvascular surgical decompression, but are widely used, especially in older patients for whom general anesthesia could pose a risk.

Prevention

There are no guidelines for preventing trigeminal neuralgia. However, once you have it, steps that may help prevent attacks include:

  • Eating soft foods
  • Eating food and drinking beverages that are room temperature
  • Washing your face with cotton pads and warm water
  • If tooth brushing triggers attacks, rinsing your mouth with warm water after eating
  • Avoiding or minimizing known triggers such as heat, cold, touch, or air