Trigeminal Neuralgia

Trigeminal neuralgia, also known as Tic douloureux, is a condition that produces severe facial pain. Classic typical type 1 trigeminal neuralgia produces occasional pain, whereas the 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. Even with type 1 trigeminal neuralgia where the discomfort often lasts only moments, the pain can be incapacitating. About 15,000 new cases are diagnosed annually in the United States.

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.

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. 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.

For additional information and support for this condition, visit the Trigeminal Neuralgia Association website at www.fpa-support.org.