Facial Pain Syndromes
Trigeminal neuralgia is a chronic pain condition that affects the trigeminal nerve, causing facial pain. The trigeminal nerve carries sensation from the face to the brain. With trigeminal neuralgia, even mild stimulation of the face can trigger a jolt of pain. This condition can be quite frightening for patients, but we offer treatments that can help.
Causes and Symptoms of Trigeminal Neuralgia
Trigeminal neuralgia occurs when the function of the trigeminal nerve is disrupted. It is most commonly caused by pressure on the trigeminal nerve from contact with an artery or vein, but in some cases, it can also be caused by pressure from tumors or brain lesions. Trigeminal neuralgia can result from aging, or it can be caused by a condition like multiple sclerosis.
Trigeminal neuralgia commonly causes pain in the cheeks, jaw, lips, gums, and teeth. It can also cause pain in the forehead and eyes in less common cases. Facial pain from trigeminal neuralgia can range from occasional, mild twinges of pain to severe episodes of jabbing, shooting pain similar to an electric shock. Pain may be contained in one spot or one side of the face, or it may spread. Pain may last for several seconds or just a few seconds, and there may be several episodes of pain for days, weeks, or months. Some patients may have periods with no pain. For some, the attacks of pain increase in frequency and intensity over time.
Trigeminal neuralgia pain can be triggered by a variety of things, including shaving, stroking the face, eating and drinking, brushing your teeth, washing your face, putting on makeup, talking, smiling, or even a light breeze.
For many of our patients, surgery is not required to treat trigeminal neuralgia. Our initial treatment recommendations often begin with medications to decrease or block the pain signals sent from the trigeminal nerve to the brain.
Anticonvulsants are commonly prescribed to treat trigeminal neuralgia, and they are generally an effective form of treatment. Muscle-relaxants may also be recommended, either alone or in combination with anticonvulsants. Trigeminal neuralgia pain often does not respond to more common painkillers and opioids, so tricyclic antidepressants may be used to treat pain.
If medications do not help, or if a patient stops responding to medication, we may recommend glycerol injections. We can administer glycerol injections on an outpatient basis. To administer the injection, we guide a thin needle through the face to an opening at the base of the skull and into a small sac of spinal fluid called the trigeminal cistern. The trigeminal cistern surrounds the central part of the trigeminal nerve, which transmits sensation to the brain. We then inject a small amount of glycerol in this space, which damages the trigeminal nerve, relieving pain. For some patients, the pain comes back after some time.
If medication and nonsurgical methods are not helpful, we may recommend surgical treatment. There are a few different surgical options for trigeminal neuralgia.
During a balloon compression, we pass a hollow needle through the face and into the base of the skull, where the trigeminal nerve runs. We then pass a catheter with a balloon on the end the needle and inflated to create pressure that will damage the nerve. The balloon is then deflated and removed. Pain relief may last for up to 2 years.
Like balloon compression, radiofrequency thermal lesioning involves passing a hollow needle through the face to an opening at the base of the skull while you are sedated. You are then awakened from sedation, and an electrode is inserted through the needle. A mild electric current is sent through the area, which will cause tingling in the affected area of the nerve. You will be asked to indicate where you feel the tingling, and will be sedated again. The electrode is then heated to damage the nerve fibers. This approach generally provides longer-lasting pain relief, but some do experience a recurrence of pain after 3 to 4 years.
Another procedure called Gamma Knife radiosurgery uses highly targeted radiation to damage the trigeminal nerve. This disrupts the pain signals sent to the brain. For some patients, the pain may return within 3 years.
Microvascular decompression is the most invasive procedure, but pain is less likely to return than it is with other treatments. It involves removing or relocating the blood vessels that are putting pressure on the trigeminal nerve.
Trigeminal Neuralgia (Facial Pain) Treatment at CNA
At Coast Neurosurgical Associates, our physicians are skilled in a variety of treatment options for chronic facial pain. If you would like to learn more about trigeminal neuralgia treatment or schedule an appointment, contact us at (562) 595-7696.