What is trigeminal neuralgia?

Trigeminal neuralgia, also known as tic douloureux, is a condition that produces severe facial pain. This pain can be incapacitating.

About 15,000 new cases are diagnosed annually in the United States.

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What are the causes of trigeminal neuralgia?

Trigeminal neuralgia is caused by vascular compression of the fifth cranial (trigeminal) nerve. It may involve one, two or, in rare instances, three branches of the nerve. It rarely occurs on both sides of the face.

What are symptoms of trigeminal neuralgia?

Symptoms of trigeminal neuralgia include severe pain, throbbing or twitching of the face.

There are two types of trigeminal neuralgia:

Classic typical type 1 trigeminal neuralgia produces occasional pain, usually lasting only moments.

Atypical type 2 trigeminal neuralgia is associated with constant, throbbing sensations. 

Often the pain can be triggered by activities such as touching your mouth, talking, eating, brushing your teeth, shaving, a cold wind, or even a light breeze.

How is trigeminal neuralgia diagnosed?

A neurological exam will be performed including touching areas of the face where the trigeminal nerve may be affected. Reflex tests will also help determine if you may have a pinched nerve or other conditions. In some cases, your doctor may inject a dye into a blood vessel to view the arteries and veins to visualize blood flow.

Magnetic resonance imaging (MRI) or a magnetic resonance angiogram may be ordered to determine if outlying causes such as a tumor is causing your trigeminal neuralgia. These procedures can be performed onsite at The Brain and Spine Imaging Center, our facility in Franklin, WI.

Is surgery necessary for trigeminal neuralgia?

Generally, a doctor will recommend non-surgical treatment options before resorting to surgery. The surgical approaches include:

Microvascular decompression:

Microvascular decompression is brain surgery to place a sponge-like material between the trigeminal nerve and adjacent blood vessels to alleviate pressure from blood flow.

Peripheral nerve branch block with phenol alcohol:

An injection into the nerve roots along the side of the head.

Percutaneous trigeminal rhizotomy with glycerol, balloon or radiofrequency:

Rhizotomy involves cutting a nerve root in the cheek.

Stereotactic radiosurgery:

Stereotactic radiosurgery is targeted radiation that destroys the trigeminal nerve so that the pain is no longer present.

What are non-surgical treatment options for trigeminal neuralgia?

Non-surgical treatment initially involves drugs such as Tegretol, Baclofen or Dilantin. If medical treatment is ineffective or if side effects of the medications are unacceptable, surgical treatment may be considered (see above).