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Trigeminal Neuralgia

  • A condition marked by facial pain from the trigeminal nerve, which carries sensation to the brain
  • Sudden facial pain that starts in the jawline and spreads to other parts of the face as it get worse
  • Treatments include anticonvulsant medications, sometimes surgery
  • Neurosurgery, multiple sclerosis & other inflammatory brain disease

Overview

For people with trigeminal neuralgia (TN), everyday activities such as eating, talking or shaving can feel like torture—triggering jolts that feel like electric shocks, aching and/or burning in the face.  Even being outside when it's windy can set off searing attacks of pain. Trigeminal neuralgia is a rare neurological condition that causes chronic and severe facial pain.

While an exact number is unknown, researchers estimate that between 10,000 to 15,000 new cases of TN are diagnosed every year. Not many physicians have experience diagnosing and treating the condition. Yale Medicine offers expertise in treatment of this and other rare neurological disorders. 

What is trigeminal neuralgia?

Trigeminal neuralgia (TN), also called tic douloureux, is caused by a malfunction in the trigeminal nerve—a large bundle of fibers at the base of the brain that is responsible for sensation in the face. 

Although the exact cause of trigeminal neuralgia is not known, it can be caused by damage to the lining of the nerve or it may be the result of an artery or a vein pushing against the trigeminal nerve. This can happen naturally as a person gets older, or it can also be caused by an injury or stroke.

TN also can be caused by multiple sclerosis, or by a tumor or another brain abnormality.

What are symptoms of trigeminal neuralgia?

Facial pain associated with TN often begins suddenly and without any apparent cause.

In many cases, it starts around the jawline, causing some patients to believe they have a dental problem. Many patients undergo dental procedures, without significant pain relief.  Then the pain worsens, spreading to other parts of the face. After a while, any movement or physical contact involving the face can cause extreme pain.

Trigeminal neuralgia pain can present in a variety of ways. The classic symptoms are sharp, throbbing, shock-like attacks lasting about 20 seconds, often triggered when something touches the face. Patients with these symptoms often have remission periods, when the pain goes away for weeks or even years. Other people with the condition experience a longer-lasting pain that is less severe but more constant and widespread. It’s often described as a burning sensation.

Some people with TN have less than one attack a day, while others have hundreds. They can also experience uncontrollable facial twitching or grimacing as a result of the pain.

TN doesn't just cause physical pain; it also can have an extreme emotional impact. TN patients may avoid social contact and fear daily activities like eating and talking. The symptoms can interfere with their ability to work and impact their relationships. Depression and sleep problems are common in TN patients, as well.

How is trigeminal neuralgia diagnosed?

Doctors can diagnose trigeminal neuralgia (TN) based on a patient's descriptions of the pain, along with a thorough physical examination.

A magnetic resonance imaging (MRI) scan may also be used to determine whether multiple sclerosis or a tumor is causing the symptoms. Other tests may also be performed to rule out other neurological disorders or causes of facial pain.

What are the risk factors for trigeminal neuralgia?

Trigeminal neuralgia (TN) affects twice as many women as men, and it’s most common in people older than 50. While some cases of TN run in families, most are not hereditary.

Having high blood pressure or smoking increases a person's risk of developing TN.  Multiple sclerosis is a well known risk factor for developing TN.  

How is trigeminal neuralgia treated?

Patients first diagnosed with trigeminal neuralgia (TN) are usually prescribed anticonvulsant medications to block pain signals to the brain. While this treatment works for most patients, it may lose effectiveness after a while, or cause side effects such as dizziness, confusion, and nausea.

If changing a patient's drug or dosage doesn't help, and a patient has failed to gain control with two medications, surgery may be helpful.

At Yale Medicine, surgery for TN can include:

  • Gamma Knife radiosurgery. In this non-invasive procedure, a focused beam of radiation is directed at the root of the trigeminal nerve. The radiation causes damage to the nerve and blunts pain signals. 
  • Microvascular decompression. In this procedure, an incision is made behind the ear and a small craniotomy is made, with a pathway opened down to the trigeminal nerve.  A tiny pad is inserted between the trigeminal nerve and any arteries putting pressure on it. If a vein is pushing on the nerve, it may be removed. Surgeons may also remove part of the trigeminal nerve if the patient's pain isn't caused by veins or arteries pressing on it.  
  • Radiofrequency Rhizotomy.  In this procedure, a needle is passed through the cheek and into the skull along the tract of the trigeminal nerve. Once positioned, an electrode is passed into position and an RF lesion is made within the trigeminal nerve.  

These procedures, and others are usually successful in relieving pain for a few years. Some of them can also be repeated if pain returns. Some surgeries carry risks, such as facial numbness or weakness, hearing loss or stroke. Our physicians strive to provide the safest and least invasive procedures possible.

What is recovery like?

Some treatments for trigeminal neuralgia (TN), such as Gamma Knife radiosurgery, are performed as non-invasive, outpatient procedures: Patients go home the same day and return to their normal activities right away.

Other procedures, such as microvascular decompression, require a longer recovery time. Because an opening is made the skull, and then closed, patients need to spend four to 10 days in the hospital and usually another week resting at home.

What makes Yale Medicine's approach to treating trigeminal neuralgia unique?

Yale New Haven Hospital is the only institution in the state of Connecticut that performs Gamma Knife radiosurgery. Our staff is experienced in diagnosing and managing rare conditions like trigeminal neuralgia (TN) and have treated over 2,400 patients. 

At the Yale Headache & Facial Pain Center, patients with TN have access to a multidisciplinary team of neurosurgeons, neurologists, pain management specialists, psychiatrists, social workers, and pharmacologists.

These physicians address both emotional and functional concerns for patients to manage their condition get the treatment they need.