Trigeminal neuralgia is a condition of the trigeminal nerve, which is a sensory nerve taking sensations from the face to the brain. In this condition the main stem of the nerve, or one of its branches are affected resulting in pain in different areas of the face.

What is trigeminal nerve?

The word trigeminal implies that it has three parts. It is a sensory nerve taking information from one side of the face to the brain, including gums and teeth. Its main stem is close to the ear where it divides in three parts: the upper part going to the forehead, the middle going to the cheek (including upper jaw), and the lower going to the jaw (including lower jaw).

What is the meaning of neuralgia?

The word neuralgia usually means a painful condition due to a problem with a nerve. In trigeminal neuralgia, the trigeminal nerve is the affected nerve.

What kind of pain occurs in trigeminal neuralgia?

The pain of trigeminal can be a mild throb but it usually is a severe sharp electric-shock type, or a piercing knife type pain. Typically, patients report jabs of electricity, or very sharp pain, at times lasting for a few seconds. It can also be called a referred pain because the area that hurts, the face, is not diseased. It is different from a pain from sinuses or a tooth infection. Typical triggers for this pain are talking, chewing, eating, drinking cold water, or just an exposure to cold air. Pain of trigeminal neuralgia can be terribly depressing, and requires urgent treatment.

What causes trigeminal neuralgia pain, and why it is so bad?

Imagine the nerve as an electric wire; if the coating of the nerve is injured, the inside part gets exposed. Anything touching that area, which may be a blood vessel or any structure around it, may trigger the pain. The reason for nerve injury can be mechanical pressure from a nearby blood vessel, or it can also be an inflammatory condition like multiple sclerosis. In a typical neuralgia the pain is not due to inflammation or infection, as in sinus or tooth infection, it is due to the injured and exposed area of the nerve. In trigeminal neuralgia, nerve gets irritated every time the patient opens his/her mouth.

How is trigeminal neuralgia diagnosed?

It is diagnosed by history of its peculiar pain and its triggers. In most cases, examination does not reveal any abnormality. Sometimes examination confirms malfunction of the trigeminal nerve. MRI of brain with contrast, with special images of the area where trigeminal nerve is, can help to find a cause.

What is the cause of trigeminal neuralgia?

In most cases, trigeminal nerve is irritated by a near-by blood vessel. Sometimes it is due to an inflammatory condition like multiple sclerosis. In rare cases, it may also be a tumor disturbing the nerve. MRI is more useful to find a mechanical cause like an artery touching the nerve, or a tumor, but less in a condition like multiple sclerosis.

What is the treatment for trigeminal neuralgia?

Pain is the main issue in trigeminal neuralgia. This is neuropathic pain (pain from a nerve pathology), which does not respond to usual pain medicines. Most effective medicines for nerve pain are some used for epilepsy, such as carbamazepine. Some other seizure medicines may also help, such as oxcarbazepine, gabapentin, pregabilin, or phenytoin.

If medicines do not work, the next line of treatment to try is a procedure called rhizotomy. In this procedure some fibers of the trigeminal nerve are destroyed to prevent spread of painful stimulus. It can be done with a chemical injection, or by heating the nerve with a probe. In more difficult cases, the de-compressive surgery to free the nerve from whatever is pressing it can be helpful.

What should I do if I have trigeminal neuralgia?

Consult a neurologist to figure out if it is trigeminal neuralgia or something else. It is not uncommon for people to consult their dentist, an orthodontist, and an ENT surgeon before they come to see a neurologist. If there is no other sign of infection, it may be better to consult a neurologist right away to avoid any delay in diagnosis and treatment.

What other conditions may look like trigeminal neuralgia?

Trigeminal neuralgia has its peculiar presentation that is unlike any other entity. Even then, it is important to consider migraine, sinus infection, atypical facial pain syndrome (not the type described above), other local facial pathologies, including temporomandibular joint problems (TMJ), or a dental ailment. Many of these conditions can easily be ruled out, e.g., if pain is affecting both upper and lower jaw, it is unlikely to be a tooth infection.

Where can I get more information about trigeminal neuralgia?

American Academy of Neurology