Trigeminal Neuralgia

Trigeminal neuralgia (TN) is a rare, chronic condition that causes sudden, excruciating pain on one side of the face. The shock-like sensation occurs in a distinct area served by the trigeminal nerve.

TN can wax and wane, sometimes manifesting as mild twinges and other times escalating to debilitating pain. In severe cases, patients describe TN symptoms as the worst pain a human can endure.

Trigeminal neuralgia symptoms

While shock-like pain episodes typically last just a few seconds, they can occur several times a day. Symptoms can include:

Lingering pain after the initial shock
Pain in just one spot or one side of the face
Pain in the gums, teeth, lips, jaw, cheek, eyes, or forehead
Episodic pain that intensifies over time

How is trigeminal neuralgia diagnosed?

Here's what to expect as you meet with your neurology team: /p>

A thorough look at your medical history and symptoms. They'll need to know specifics like timing, frequency, location, and triggers.
A comprehensive physical exam. They'll assess your facial sensation and other nerve functions.
Imaging tests, such as a magnetic resonance angiography (MRA). This scan is similar to an MRI but focuses on your blood vessels.

Your care team will evaluate all these factors to determine whether you have trigeminal neuralgia.

Treatment options

After your diagnosis, you’ll discuss treatments and therapies with your neurology team.

Medications

Anti-seizure medications are usually the first choice for pain relief. Your neurologist might prescribe:

Carbamazepine (brand name Tegretol)
Gabapentin (Neurontin)
Pregabalin (Lyrica)
Oxcarbazepine (Trileptal)

One medication or a combination is usually enough to manage the pain. Common side effects include drowsiness, nausea, difficulty concentrating, or loss of balance.

Surgery

You might find that the medications don't control the pain or your body can't tolerate the side effects. At this point, your neurology team may suggest surgery.

Microvascular decompression

This procedure relieves pressure caused by a blood vessel that is pressing on the trigeminal nerve. A neurosurgeon will separate the vessel from the nerve with a Teflon cushion. This is the only surgery that can alleviate symptoms while preserving trigeminal nerve function.
Microvascular decompression is by far the most effective surgical treatment. More than 80% of patients who get this procedure from our experienced team feel immediate pain relief with long-lasting results.
CyberKnife® radiosurgery

During a CyberKnife procedure, radiation beams are delivered to the trigeminal nerve with pinpoint accuracy to dull the pain. There is no cutting, blood loss, or hospital stay. MedStar Health specialists were the first on the East Coast to adopt CyberKnife, and we are among the most experienced users in the world.
CyberKnife is best suited for patients whose age or medical conditions make them ineligible for open surgery. The treatment is painless and lasts only about 45 minutes. Most patients feel less facial pain within several days to weeks. Pain may return in some patients at lower levels several years after treatment.
Percutaneous balloon rhizotomy

In this technique, performed under general anesthesia, a neurosurgeon inserts a needle containing a deflated balloon near the corner of your mouth. Guided by X-ray, the surgeon advances the needle through the base of the skull to the root of the trigeminal nerve. Once that target is reached, they’ll inflate a balloon. This dulls the pressure on the trigeminal nerve, making the painful sensation disappear.
This is an outpatient procedure performed under general anesthesia. No overnight hospital stay required. Most patients have less facial pain immediately after the procedure, with varied rates of recurrence.
Percutaneous radiofrequency rhizotomy

This is like balloon rhizotomy except it is done under sedation rather than general anesthesia so patients can participate in testing during the procedure. Mini electrical pulses are sent through the needle to mimic TN shocks and simulate your pain distribution. Radiofrequency (heat)is sent through the needle to dull the trigeminal nerve.
There is no hospital stay after this outpatient procedure, and most patients feel pain relief when they leave the hospital.