Trigeminal Neuralgia

Trigeminal Neuralgia (Tic Douloureux)

Trigeminal neuralgia, also known as tic douloureux, is a chronic pain condition causing recurrent episodes of extreme, sporadic burning or electric shock-like pain. Pain typically occurs in the lower face and jaw, but it can affect the area around the nose and above the eye. In almost all cases, pain is felt on one side of the face, only. Though a tic douloureux episode only lasts a few seconds to a minute or two, the pain is excruciating and can be mentally and physically incapacitating.

Symptoms of Trigeminal Neuralgia

Trigeminal neuralgia pain disrupts the ability to complete tasks or think clearly. Female patients have described the condition as worse than childbirth, and in the early 20th century, it was sometimes called the “suicide disease.” Depending on the person, trigeminal neuralgia pain may feel like:

• Sharp knife slicing
• Being tazed
• Blowtorch burning
• Hot ice-pick stabbing
• Electrical storm
• Razor scraping
• Knife hammering
• Throbbing, piercing, or stabbing

Triggers & Causes of Trigeminal Neuralgia

Trigeminal neuralgia attacks are often triggered by vibration or contact with the cheek during shaving, brushing teeth, eating, drinking, talking, or wind exposure. Attacks can worsen over time, with fewer and shorter pain-free periods between episodes. Some patients experience a tingling or numbing sensation in the face in the days preceding an attack.

Irritation of the fifth cranial nerve (the trigeminal nerve) causes this type of neuralgia. Neuralgia may arise as part of the aging process, but in some cases, it is associated with another disorder like multiple sclerosis or similar conditions that damage the myelin sheath nerve covering. The pain disorder most often affects people over 50, but it can arise at any age. It is more common in women than men, though the reasons for this are unknown. There is some evidence that trigeminal neuralgia may be inherited due to a genetic pattern of blood vessel formation.

Nerve irritation may be caused by:

• Blood vessels pressing on the trigeminal nerve
• Growths or lesions at the base of the skull
• Tumors

Diagnosis of Trigeminal Neuralgia

Several tests may be performed to identify problems and rule out other facial pain causes. These include magnetic resonance imaging (MRI), CT scans, or x-rays. MRIs detect whether a tumor or multiple sclerosis is irritating the trigeminal nerve, but imaging of the brain may not reveal the precise cause of the pressure. Dr. Mark McLaughlin, MD is a leading international specialist in diagnosing and treating trigeminal neuralgia. Schedule a consultation with Dr. McLaughlin now.

Non-Surgical Trigeminal Neuralgia Treatment

Though extremely painful, trigeminal neuralgia is not life-threatening. The goal of treatment is to relieve or minimize pain and restore quality of life. Conservative treatment options include:

• Medication: Treatment of trigeminal neuralgia usually begins with a drug that blocks or reduces pain signals sent from facial nerves (trigeminal branches) to the brain. An antiseizure medication, also called an anticonvulsant, is the most commonly prescribed drug. These medications suppress the excessive nerve activity that causes pain. Drug side effects include dizziness, confusion, drowsiness, double vision, and nausea. If medication is ineffective or loses effectiveness over time—or if side effects are unbearable—other options are available.
• Injections: Nerve blocks using local anesthetic can be injected into the trigger area/pain site for temporary relief. Alcohol injections may provide temporary pain relief by numbing affected areas of the face. Side effects include infection, bleeding, or nerve damage. While effective for a short period, these injections are not a permanent solution to trigeminal neuralgia. Injections of glycerol around the trigeminal ganglion can damage the fibers that conduct pain signals. Under general anesthesia or using intravenous sedation, a small amount of glycerol may be injected into the chamber housing the nerve ganglion at the skull’s base. The initial success rate of this procedure is very high, and most patients enjoy immediate pain relief. However, the chance of reoccurrence increases over time and additional injections become less effective.

Surgery & Gamma Knife Radiosurgery for Trigeminal Neurosurgery

Surgery is useful for cases that do not benefit from medication.

The goal of surgery for trigeminal neuralgia is to relieve nerve pressure or reduce sensitivity by moving the blood vessels away from the trigeminal nerve. Microvascular decompression is the most commonly used surgical treatment for healthy people looking for the longest-lasting, least damaging option. Microvascular decompression relieves trigeminal neuralgia by placing a small pad between the trigeminal nerve and adjacent blood vessels. More than 80 percent of patients experience long-term pain relief with this solution and have normal face sensation after the procedure. Serious complications are rare, and there is a low chance of reoccurrence.

Gamma Knife radiosurgery delivers a high dose of radiation to the root of the trigeminal nerve, damaging the nerve and reducing or eliminating pain. Radiofrequency treatments relieve trigeminal neuralgia by damaging or destroying trigeminal nerve cells.

Renowned Expertise in Trigeminal Neuralgia Treatment

Princeton Brain, Spine & Sports Medicine is a leading U.S. provider of the Janetta procedure, the gold standard for trigeminal neuralgia treatment. Dr. Mark R. McLaughlin, MD, FACS, FAANS trained with Peter Janetta, MD—the father of modern microvascular decompression surgery for trigeminal neuralgia, hemifacial spasm, glossopharyngeal neuralgia, and other cranial nerve rhizopathies. Working closely with Dr. Janetta in ongoing neuralgia research, Dr. McLaughlin was the lead author of the paper, “Microvascular decompression of cranial nerves: lessons learned after 4400 operations,” published in the Journal of Neurosurgery in January 1999.

Dr. McLaughlin has successfully treated trigeminal neuralgia for over 15 years, and PBSSM’s affiliation with leading research hospitals keeps our centers at the forefront of breakthrough treatment techniques for trigeminal, occipital, and glossopharyngeal neuralgias.

If trigeminal neuralgia pain has become debilitating or you are experiencing reoccurrence after prior treatment, PBSSM can help. Call to schedule a diagnostic examination with Dr. McLaughlin: 215.741.3141 in Pennsylvania or 609.921.9001 in New Jersey. To request information about our neurosurgeons’ advanced spinal, cranial, and neurosurgical care, contact PBSSM online. Our patient-focused practice is committed to your health, well-being, and quality of life.

Additional Resources

What Causes Trigeminal Neuralgia? – Video by Dr. Mark McLaughlin