Trigeminal Neuralgia (TGN) is a nervous system condition characterized by sharp, shooting, electrical facial pain into one or more branches of the trigeminal nerve, a major cranial nerve that provides sensation to one side of the face. This condition can affect the forehead and scalp, eyes, nose, upper and lower teeth, lips and jaw. Attacks can last weeks to months and are disabling, even leading to chronic depression. This pain is seen more commonly in women than men, usually in the 50- to 70-year age range.
The specific cause is unknown, but it may be related to sclerosis, nerve tumors (neuromas), lesions in a specific region of the brain or trauma. The clinical symptoms of TGN are pain in one or even two of the three branches of the trigeminal nerve. Symptoms are typically described as stabbing or “lightening bolt” pain, occurring out of the clear blue, followed by intervals of feeling pain-free. The pain, which is increased with the cold, can often be triggered by washing the face, brushing teeth, shaving, chewing, swallowing or talking.
There is no definitive tool to diagnose TGN. MRIs will rule out multiple sclerosis and intracranial masses or tumors. A good dental exam will rule out tooth or gum disorders. A detailed history of pain, aggravating factors and a neurological exam will be key factors in the diagnosis of what branches of the nerve are affected.
The treatment of TGN is both medical and surgical. Initial treatment is with an anticonvulsant such as Carbamazepine® or Tegretol®. Other anticonvulsants such as Neurontin® and Topamax® have also been found to be useful. Opiates or narcotics are not considered first line treatment options but have been used with some success. Local injections of steroids with anesthetic within the region of the specific branches of the trigeminal nerve have been very useful. Radiofrequency ablation or destruction of the nerve; cryotherapy, in which an ice ball is formed around the affected nerve; and chemical destruction of the trigeminal nerve may provide up to two years of pain control. Glycerol injections, balloon decompression and radiofrequency of the gasserian ganglion may be performed with relief lasting up to three years or more.
The surgical treatment of choice is microvascular decompression. A piece of material is placed between the trigeminal nerve and adjacent vessels and is associated with up to 10 years of pain relief. This procedure is a last resort and is a considered a major surgical procedure, so only certain patients will be candidates.
The MidSouth Pain Treatment center can provide both medical management and surgical management of TGN with local steroid injections and radiofrequency nerve destruction. We are committed to helping our patients with this debilitating disease.