Trigeminal neuralgia

Definition

Trigeminal neuralgia (TN) is a nerve disorder. It causes a stabbing or electric shock-like pain in parts of the face.

Alternative Names

Tic douloureux; Cranial neuralgia; Facial pain - trigeminal; Facial neuralgia; Trifacial neuralgia; Chronic pain - trigeminal; Microvascular decompression - trigeminal

Causes

The pain of TN comes from the trigeminal nerve. This nerve carries the sensations of touch and pain from the face, eyes, sinuses, and mouth to the brain.

Trigeminal neuralgia may be caused by:

Often, no exact cause is found. TN usually affects adults above age 50 years, but it can occur at any age. Women are affected more often than men. When TN affects people younger than 40, it is often due to MS or a tumor.

Symptoms

Symptoms may include any of the following:

Painful attacks of trigeminal neuralgia can be triggered by common, everyday activities, such as:

The right side of the face is mostly affected. In some cases, TN goes away on its own.

Exams and Tests

A brain and nervous system (neurologic) examination is often normal. Tests that are done to look for the cause may include:

Treatment

Your primary care doctor, a neurologist, or a pain specialist may be involved in your care.

Certain medicines sometimes help reduce pain and the rate of attacks. These medicines include:

If you are found to have multiple sclerosis (MS) as a cause of TN, your doctor will discuss medicines that can treat the underlying MS.

Short-term pain relief occurs through surgery, but is associated with risk of complications. One surgery is called microvascular decompression (MVD) or the Jannetta procedure. During surgery, a sponge-like material is placed between the nerve and the blood vessel that is pressing on the nerve.

Trigeminal nerve block (injection) with local anesthetic and steroid is an excellent treatment option to rapidly relieve pain while waiting for medicines to take effect.

Other techniques involve destroying or cutting parts of the trigeminal nerve root. Methods used include:

If a tumor is the cause of TN, surgery is done to remove it.

Outlook (Prognosis)

How well you do depends on the cause of the problem. If there is no disease causing the problem, treatment can provide some relief.

In some people, the pain becomes constant and severe.

Possible Complications

Complications may include:

When to Contact a Medical Professional

Contact your health care provider if you have symptoms of TN, or your TN symptoms get worse.

References

Bendtsen L, Zakrzewska JM, Heinskou TB, et al. Advances in diagnosis, classification, pathophysiology, and management of trigeminal neuralgia. Lancet Neurol. 2020;19(9):784-796. PMID: 32822636 pubmed.ncbi.nlm.nih.gov/32822636/.

Gonzales TS. Facial pain and neuromuscular diseases. In: Neville BW, Damm DD, Allen CM, Chi AC, eds. Oral and Maxillofacial Pathology. 4th ed. St Louis, MO: Elsevier; 2016:chap 18.

Wallenstein J.. Brain and cranial nerve disorders. In: Walls RM, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 91.

Waldman SD. Trigeminal neuralgia. In: Waldman SD, ed. Atlas of Common Pain Syndromes. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 10.


Review Date: 4/25/2022
Reviewed By: Joseph V. Campellone, MD, Department of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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