Trigeminal Neuralgia

Pain due to trigeminal neuralgia can occur spontaneously but is often triggered by touching a particular spot (called a trigger point) on the face, lips, or tongue or by an action such as brushing the teeth or chewing. Repeated short, lightning-like bursts of excruciating stabbing pain can be felt in any part of the lower portion of the face but are most often felt in the cheek next to the nose or in the jaw.

Usually, only one side of the face is affected. The pain usually lasts seconds but may last up to 2 minutes. Recurring as often as 100 times a day, the pain can be incapacitating. Because the pain is intense, people tend to wince, and thus the disorder is sometimes called a tic. The disorder commonly resolves on its own, but bouts of the disorder often recur after a long pain-free interval.

Although no specific test exists for identifying trigeminal neuralgia, its characteristic pain usually makes it easy for doctors to diagnose. MRI of the brain is done to determine whether an artery is crossing the nerve. This information may guide future therapy. Brain MRI can also determine whether a tumor is compressing the nerve. However, doctors must distinguish trigeminal neuralgia from other possible causes of facial pain, such as disorders of the jaw, teeth, or sinuses.

Because the bouts of pain are brief and recurrent, typical analgesics are not usually helpful, but other medications, especially certain antiseizure medications Antiseizure drugs In seizure disorders, the brain's electrical activity is periodically disturbed, resulting in some degree of temporary brain dysfunction. Many people have unusual sensations just before a seizure... read more , taken by mouth, may help. (Antiseizure medications stabilize nerve cell membranes.) The antiseizure medication carbamazepine is usually tried first. Oxcarbazepine, lamotrigine, gabapentin, or phenytoin, which are also antiseizure medications, may be prescribed if carbamazepine is ineffective or has intolerable side effects.

Baclofen (a medication used to reduce muscle spasms) or amitriptyline (a tricyclic antidepressant Heterocyclic (including tricyclic) antidepressants Several types of medications can be used to treat depression: Selective serotonin reuptake inhibitors (SSRIs) Norepinephrine-dopamine reuptake inhibitors, serotonin modulators, and serotonin-norepinephrine... read more ) may be used instead. If amitriptyline has intolerable side effects, another tricyclic antidepressant may be tried.

Injecting botulinum toxin (used to paralyze muscles or to treat wrinkles) near the area where pain is experienced may help, but evidence of its effectiveness is limited.

If bouts of pain are frequent and severe, doctors may use a nerve block to temporarily relieve the pain until the medication given by mouth takes effect. An anesthetic is injected into the nerve to temporarily block its function.

If the pain continues to be severe despite medication, surgery may be done. If the cause is an abnormally positioned artery, a surgeon separates the artery from the nerve and places a small sponge between them. This procedure (called vascular decompression) usually relieves the pain for many years. If the cause is a tumor, the tumor can be surgically removed.

If people have pain unrelieved by medications and surgery seems too risky, a nerve block can be done to determine whether other procedures would help. If the injection of the anesthetic into the nerve relieves the pain, disrupting the nerve may relieve the pain, sometimes permanently. Disruptions may involve

However, surgery that relieves pain often results in facial numbness. Also, pain often recurs. As a result, people may require many procedures. Having many procedures may increase the risk of developing severe pain that is difficult to treat.