What is Trigeminal Neuralgia?
Trigeminal neuralgia (TGN) causes severe, stabbing, electric shock-like pain in your face when a blood vessel or other lesion touches your trigeminal nerve. It most often affects your lower face and jaw, although it sometimes occurs around your nose and above your eye.
Many common activities can trigger trigeminal pain: shaving, washing your face, applying make-up, brushing your teeth, laughing, chewing, drinking, talking, and sometimes even just breathing. Touching your cheek, feeling a vibration, or even a breeze or heat and cold can trigger intense flashes of pain. Episodes can last for days, weeks, or months at a time and then disappear for months or years. The attacks often worsen over time, with fewer and shorter pain-free periods.
Trigeminal neuralgia occurs most often in people over age 50, but it can occur at any age. It affects women more often than men.
Diagnosis and Treatment
When you come to Mount Sinai, we conduct a thorough neurological examination to determine the cause of your facial pain. We ask you to describe your symptoms, such as the intensity of your pain, where the pain occurs, and when it occurs.
The symptoms of trigeminal neuralgia are similar to multiple sclerosis, tumors, and some infections, so we may do some diagnostic imaging tests to be certain of the diagnosis. Magnetic resonance imaging is usually most helpful and enables us to take pictures of structures inside your head to help with diagnosis.
Typically, the first line of treatment for trigeminal neuralgia is anticonvulsant drugs and other medications to control the symptoms. The pain often worsens over time, so the medication that controlled your pain initially may gradually become less effective.
If medication does not relieve your symptoms, or if it causes undesirable side effects such as nausea, dizziness, confusion, or severe drowsiness, we may recommend surgery. We use both ablative (destructive) and non-ablative (non-destructive) procedures to help.
Ablative procedures injure or partially destroy the trigeminal nerve, which lessens the transmission of pain. These minimally invasive procedures, including percutaneous techniques and stereotactic radiosurgery, involve radiation, chemicals, electricity, or compression.
These procedures damage your trigeminal nerve fibers, which often causes some degree of facial numbness. This numbness generally does not cause problems. If you have an ablative procedure, you are more likely to experience a recurrence than if you have a microvascular decompression.
Non-ablative procedures spare your nerve function by addressing the primary cause of trigeminal neuralgia, vascular compression. Microvascular decompression (MVD), performed under general anesthesia, is the most common non-ablative technique and it leaves your trigeminal nerve intact. We make a small opening in the back of your skull on the side where you feel the pain. We look at your trigeminal nerve with a microscope and move the compressing blood vessels away from the nerve. Then we add a protective pad, usually made of shredded Teflon, or a sponge to protect the nerve and prevent recurrence.
This treatment is not for everyone. It is most effective if you meet these criteria:
- Your pain is only on one side of your face.
- Anticonvulsant medicines worked well for you at first.
- Your pain follows the pathway of the trigeminal nerve.
- Your pain comes and goes and is not constant.
If you are a good candidate for MVD, it is generally highly effective and has a very low complication rate of the procedure. Recurrence is rare.
Mount Sinai's Joshua B. Bederson, MD, Professor and Chair of the Department of Neurosurgery, and Raj K. Shrivastava, MD, Assistant Professor of Neurosurgery, have excellent success rates using MVD on carefully selected patients.