Trigeminal neuralgia (TN) is a chronic, painful condition that involves the fifth (5th) cranial nerve. This condition produces neuropathic (nerve-related) pain, which occurs due to a lesion or injury of the trigeminal nerve.
What is the trigeminal nerve?
The 5th cranial nerve is one of 12 pairs of nerves that branch off the brain. The trigeminal nerve has three main branches, and each conducts sensations for the upper, middle, and lower areas of the face. These branches stimulate the cheek, upper jaw, teeth, gums, and sides of the nose. Usually 2-3 branches are affected by TN, but the condition rarely affects both sides of the face.
What are the different kinds of trigeminal neuralgia?
Also called tic douloureux, trigeminal neuralgia has two forms. These are:
- Type 1 TN – Also called classic type trigeminal neuralgia, type 1 causes extreme, sporadic, and sudden pain of searing, burning, or shock-like quality. The pain can last a few seconds, or it may persist for several hours. These painful episodes often occur in quick succession, which can last for up to three hours.
- Type 2 TN – Called atypical trigeminal neuralgia, this condition is characterized of a lower intensity pain, which is described as aching, stabbing, burning, and throbbing.
What causes trigeminal neuralgia?
The cause of trigeminal neuralgia is not well understood. Experts believe it is caused by a blood vessel that presses on the nerve when it exits the brain stem. The pressure leads to erosion of the myelin sheath, which is the protective nerve coating. Many people with multiple sclerosis have symptoms of TN, as this disease results in deterioration of the trigeminal nerve’s myelin sheath. Another cause of TN is nerve compression related to an arteriovenous malformation (tangled mass of veins and arteries) or a tumor.
What are the symptoms of TN?
The pain of trigeminal neuralgia varies from person-to-person. Pain can be moderate or severe, sudden or gradual, aching or stabbing, burning or constant. The pain is usually triggered by light touch, vibration, or mild stimuli, such as brushing the teeth, taking, and exposure to wind. People with TN have painful episodes that occur in clusters, with many pain-free intervals in between the painful episodes. While trigeminal neuralgia is not fatal, it can be debilitating and difficult to treat.
How common is trigeminal neuralgia?
Trigeminal neuralgia affects 12 per 100,000 people every year in the U.S., and the disorder is more common among women than men. TN occurs more often in people age 50 years and older, but it can occur at any age.
How is trigeminal neuralgia diagnosed?
There is no blood or imaging test that can diagnose trigeminal neuralgia. The diagnosis is made based on the patient’s symptoms and pain description. The doctor will ask questions about your pain, take a medical history, and conduct a thorough clinical examination.
How is TN treated?
The Boulder pain management physician often uses many treatments in combination to control the symptoms associated with trigeminal neuralgia. Treatment options include:
- Tricyclic antidepressants – These medications change the way the brain perceives pain by acting on certain neurotransmitters. Examples include amitriptyline and nortriptyline.
- Anticonvulsants – The drugs work by blocking nerve signal transmission, thus interfering with pain pathways. Examples include carbamazepine, oxcarbazepine, topiramate, gabapentin, and pregabalin.
- Narcotic analgesics – These drugs work on the level of the central nervous system. They are prescribed short-term due to side effects and addictive potential. Examples include tramadol, hydrocodone, and oxycodone.
- Rhizotomy – Also called rhizolysis, this procedure is used to deactivate certain nerve fibers associated with the trigeminal nerve. The doctor inserts a tiny cannula through the cheek and positions it near the nerve. Fluoroscopy (x-ray guidance) is used for correct placement. A small balloon is inflated, which compresses the nerve relieving pressure. Pain relief associated with this procedure last for up to two years. In a recent clinical study, the success rate for rhizotomy was 92%.
- Radiofrequency ablation – This procedure is similar to the rhizotomy except radiofrequency energy is used to destroy a portion of the nerve root. This offers long-term pain relief.
- Microvascular decompression (MVD) – With this procedure, the doctor makes a tiny incision behind the ear. A small scope is inserted so the surgeon can view the nerve. The doctor will use special tiny tools to make repairs to the nerve. In a medical study involving 40 patients with TN, MVD had a 98% efficacy rate for pain relief.
- Stereotactic radiosurgery – For severe cases of TN, the doctor can perform a procedure also called “cyber knife.” This involves use of computer imaging to direct focused radiation beams on the portion of the nerve that exits the brain stem. This will slow lesion formation, if a tumor is present, and it can disrupt painful nerve signal transmission.
Colorado Clinic offers top treatment for trigeminal neuralgia at several locations. This includes Boulder, Loveland, Greeley, Longmont and surrounding areas. Call us today!
Ashkan K & Marsh H (2004). Microvascular decompression for trigeminal neuralgia in the elderly: a review of the safety and efficacy. Neurosurg, 55(4), 840-348.
Harries AM & Mitchell RD (2011). Percutaneous glycerol rhizotomy for trigeminal neuralgia: safety and efficacy of repeat procedures. Br Jour Neurosurg, 25(2), 268-272.