Trigeminal Neuralgia: Causes, Symptoms & Treatment

Ever wondered what Trigeminal neuralgia is? Find out how this condition manifests itself, what are its main symptoms and what you can do to treat it. Bonus, what’s the connection between Trigeminal Neuralgia and bananas?

What is Trigeminal Neuralgia

Trigeminal neuralgia (TN), also known as tic douloureux, is a chronic pain condition that affects the trigeminal nerve, the fifth cranial nerve. This nerve is responsible for providing sensation to the face, including the forehead, cheeks, jaw, and teeth.

People with TN experience sudden and severe attacks of facial pain that can be described as electric shock-like, stabbing, or burning. These attacks can last from a few seconds to several minutes and can be triggered by certain activities, such as brushing your teeth, shaving, or even applying makeup.

Trigeminal Neuralgia causes

Classical trigeminal neuralgia is the most common type, accounting for about 85% of cases. It is caused by compression of the trigeminal nerve by a blood vessel, usually near the brainstem.

This compression can lead to the wearing away or damage of the protective coating around the nerve (the myelin sheath), which increases the sensitivity of the nerve and can result in episodes of severe facial pain.

Symptomatic trigeminal neuralgia is less common and is caused by damage to the trigeminal nerve from other conditions, such as

• Blood Vessel Compression: The most common cause, where an artery or vein compresses the trigeminal nerve. This pressure can cause the nerve to malfunction, leading to intense pain.
• Multiple Sclerosis (MS): MS can damage the myelin sheath, the protective covering of the nerves, including the trigeminal nerve. This demyelination can lead to trigeminal neuralgia in some cases.
• Tumor: A tumor pressing against the trigeminal nerve can cause symptoms similar to trigeminal neuralgia. The tumor may cause pressure on the nerve, leading to irritation or damage.
• Arachnoid Cyst: An arachnoid cyst in the vicinity of the trigeminal nerve can also exert pressure on the nerve, leading to trigeminal neuralgia.
• Trauma: Physical trauma to the face or head can damage the trigeminal nerve, leading to trigeminal neuralgia. Similarly, surgical procedures in the area can sometimes lead to nerve damage.
• Infection: Certain infections can affect the trigeminal nerve. For example, shingles (herpes zoster) can infect nerves and potentially lead to postherpetic neuralgia, which might affect the trigeminal nerve in rare cases.
• Shingles infection: This viral infection can damage the trigeminal nerve, leading to post-herpetic neuralgia, a chronic pain condition.
• Aneurysms: An aneurysm near the trigeminal nerve can exert pressure similar to that of a blood vessel, causing trigeminal neuralgia.
• Other Neurological Disorders: Conditions that cause damage to or affect the functioning of nerves can potentially lead to trigeminal neuralgia.

It’s important to note that in some cases, the exact cause of trigeminal neuralgia cannot be determined, which is referred to as idiopathic trigeminal neuralgia. Diagnosis typically involves a detailed medical history, physical examination, and imaging studies such as magnetic resonance imaging (MRI) to identify any underlying causes that may be treatable.

Trigeminal Neuralgia symptoms

Trigeminal neuralgia symptoms are distinctive and can be extremely debilitating for those affected. The condition is characterized by episodes of sudden, severe, electric shock-like or stabbing pain that affects the face. These episodes can be triggered by common, everyday activities.

Here are the key symptoms and characteristics of trigeminal neuralgia:

• Pain Episodes: The pain of trigeminal neuralgia is described as a sudden, sharp, electric shock-like, or stabbing pain that can last from a few seconds to two minutes per episode. These episodes can occur in quick succession over a period of two hours or longer.
• Triggers: The pain can be triggered by very light touches to the face or other seemingly benign activities, such as brushing teeth, chewing, speaking, touching the face lightly, applying makeup, swallowing, or even a breeze blowing across the face.
• Affected Areas: The pain typically affects one side of the face, although in rare cases, it can affect both sides (though not usually at the same time). It commonly involves the lower face and jaw, although it can also affect the area around the nose, cheeks, forehead, and eyes.
• Pain-Free Intervals: Between episodes, there may be a pain-free interval of varying length. However, attacks may become more frequent and intense over time.
• Types of Pain: The intensity of pain can vary from mild to severe. It is often described as one of the most intense types of pain known.
• Nocturnal Pain: Interestingly, trigeminal neuralgia attacks often do not occur during sleep, which can help differentiate it from other types of facial pain.
• Tic-Like Spasms: In some cases, the intense pain can cause involuntary twitching or spasms of the facial muscles, referred to as tic douloureux.

The symptoms of trigeminal neuralgia can significantly impact the quality of life, leading to anxiety or depression in some patients due to fear of triggering the next attack.

How is Trigeminal Neuralgia diagnosed

Diagnosing Trigeminal Neuralgia primarily involves a detailed medical history and physical examination, focusing on the symptoms and triggers of the pain.

Because there are no specific tests that can definitively diagnose trigeminal neuralgia, the diagnosis is often based on the patient’s description of the pain, including its type, location, and triggers.

Certain tests can be used to rule out other conditions and to identify any underlying causes of neuralgia.

Here are the steps and tools commonly used in diagnosing trigeminal neuralgia:

Medical History

The doctor will ask about the nature of the pain, including how it feels, how long it lasts, what seems to trigger it, and what provides relief. The description of the pain as sudden, sharp, and like an electric shock is a key indicator of trigeminal neuralgia.

Physical Examination

During the physical exam, the doctor may touch various parts of your face to try to trigger the pain. This helps to determine the affected branches of the trigeminal nerve and to assess the condition’s impact.

Magnetic Resonance Imaging (MRI)

An MRI scan can help to rule out other causes of facial pain, such as a tumor or multiple sclerosis. In some cases, an MRI can show if a blood vessel is compressing the trigeminal nerve.

Some patients may undergo a type of MRI called a “trigeminal neuralgia protocol” or “FIESTA sequence,” which can provide detailed images of the nerve and surrounding structures.

Referral to a Specialist

Patients with suspected trigeminal neuralgia may be referred to a neurologist or a pain specialist for further evaluation and management. These specialists can offer more detailed assessments and treatment options.

Additional Tests

In some cases, additional tests may be performed to exclude other conditions that could mimic Trigeminal Neuralgia, such as dental problems, temporomandibular joint disorders, or sinus infections.

Response to Medication

Sometimes, the diagnosis is further supported by a patient’s response to medication typically used to treat Trigeminal Neuralgia, such as carbamazepine or oxcarbazepine. A significant reduction in pain after starting these medications can help confirm the diagnosis.

Trigeminal Neuralgia treatment

Treatment for Trigeminal Neuralgia aims to reduce or eliminate the pain, improve quality of life, and minimize any side effects of the treatment itself. The approach can vary based on the severity of the symptoms, the patient’s overall health, and their response to initial treatments.

Here’s an overview of the primary treatment options:

Medication

• Anticonvulsants: These are the first line of treatment. Drugs such as carbamazepine (Tegretol, Carbatrol) and oxcarbazepine (Trileptal) are effective in blocking nerve firing and are commonly used to treat trigeminal neuralgia. Other anticonvulsants that may be used include gabapentin (Neurontin), lamotrigine (Lamictal), and phenytoin (Dilantin).
• Muscle Relaxants: These can be used alone or in combination with anticonvulsants. Baclofen is a muscle relaxant that is sometimes effective in treating trigeminal neuralgia.
• Antispasmodic Agents: Medications such as botulinum toxin (Botox) injections have been used to treat trigeminal neuralgia, particularly in patients who do not respond to other medications.

Trigeminal Neuralgia surgery and related procedures

When medications are ineffective or cause intolerable side effects, several surgical options and procedures are available:

• Microvascular Decompression (MVD): This surgery involves relocating or removing blood vessels that are compressing the trigeminal nerve. It’s considered when vascular compression is identified and can offer a long-term solution for many patients.
• Gamma Knife Radiosurgery (Stereotactic Radiosurgery): A focused dose of radiation is directed at the root of the trigeminal nerve, causing a lesion that disrupts pain signals. This procedure is non-invasive and can be an option for patients who are not candidates for more invasive surgery.
• Balloon Compression: A balloon is inserted through a catheter into the area where the nerve goes through the base of the skull. Inflating the balloon compresses the nerve, damaging the pain-causing fibers.
• Glycerol Injection: Glycerol is injected into the area where the nerve splits into three branches, damaging the nerve fibers and blocking pain signals.
• Radiofrequency Thermal Lesioning: A needle is inserted through the face and into the trigeminal nerve. Radiofrequency current is then passed through the needle to heat up and damage the nerve fibers responsible for pain.

Complementary and Alternative Medicine

Some patients find relief through acupuncture, chiropractic care, biofeedback, or nutritional therapy, although evidence supporting these treatments is limited. Discuss these options with a healthcare provider to ensure they complement the overall treatment plan safely.

Lifestyle and Home Remedies

Adjusting daily routines to avoid known triggers can help manage symptoms. Strategies may include eating soft foods, avoiding extreme temperatures, and protecting the face from the wind.

Management Approach

The management of trigeminal neuralgia is often progressive, starting with medications and advancing to surgical options if necessary. Regular follow-ups with healthcare providers are essential to adjust the treatment plan as needed.

FAQ on Trigeminal Neuralgia