Diagnosis
Given that the pain from trigeminal neuralgia can be felt in the jaw, cheeks, or mouth, many individuals initially consult their dentist. The dentist can examine your mouth and teeth to rule out dental issues as the source of the pain. If a dental cause is not identified, the dentist might recommend a visit to your primary care physician.
Your doctor will begin by reviewing your medical history and asking detailed questions about your symptoms, particularly the nature of your pain. A physical exam will also be conducted to assess sensation in your face and the strength of your masticatory muscles—the muscles used for chewing.
A specialist in orofacial pain, who focuses on diagnosing and treating pain in the mouth and face, or a neurologist, a specialist in nervous system disorders, might also be involved in your care team.
An MRI (magnetic resonance imaging) of the brain may be performed. This imaging can reveal if a blood vessel is compressing the trigeminal nerve and the extent of this compression. It can also help identify any secondary causes of the condition.
Diagnosing trigeminal neuralgia can sometimes be challenging because numerous conditions can cause facial pain. However, pinpointing the exact cause of your pain is crucial for receiving the appropriate treatment.
Treatment
Treatment for trigeminal neuralgia typically starts with medication. When medication is not sufficient to manage the pain, or if side effects become intolerable, surgery may be considered.
Medications
Several medications are available to treat trigeminal neuralgia. These can be used individually or in combination to achieve better pain control.
The table below lists some classes of medications used for trigeminal neuralgia:
Medications for Trigeminal Neuralgia
| Medication Class | Examples | Key Information |
|---|---|---|
| Anticonvulsants | Carbamazepine, Oxcarbazepine, Phenytoin, Others | These are typically the first-line medications recommended by healthcare providers. |
| Muscle Relaxants | Baclofen | Baclofen is particularly beneficial for individuals with trigeminal neuralgia related to multiple sclerosis. |
| Antidepressants | Amitriptyline, Nortriptyline | These tricyclic antidepressants can be effective in managing the pain associated with trigeminal neuralgia. |
| Neurotoxins | Botulinum toxin type A injections | Botulinum toxin type A injections work by blocking the release of substances necessary for nerve cells to communicate. Current evidence suggests they can be helpful when other medications are ineffective. |
It is important to ask your healthcare provider about the need for monitoring while taking these medications. For some, regular blood tests are necessary to ensure they are not causing adverse effects on your body.
Surgery
Surgery is considered when medications fail to provide relief, when side effects are too severe, or when imaging indicates a blood vessel pressing on the trigeminal nerve.
There are two main categories of surgical procedures for trigeminal neuralgia:
- Ablation or controlled lesion procedures, where trigeminal nerve fibers are intentionally damaged to block pain signal transmission.
- Open surgery, where the trigeminal nerve is separated from the blood vessel compressing it.
See the tables below for further details.
Surgeries for Trigeminal Neuralgia
Ablation or Controlled Lesion Procedures
| Procedure Name | How the Lesion is Created |
|---|---|
| Balloon Compression | Pressure exerted by a balloon on the nerve |
| Glycerol Injection | A thick, colorless liquid called glycerol |
| Radiofrequency Ablation | Heat |
| Stereotactic Radiosurgery (Gamma Knife, CyberKnife) | Radiation |
Balloon compression, glycerol injection, and radiofrequency ablation can be performed by inserting a small tube or needle through the cheek to deliver the treatment. For radiosurgery, a specialized machine delivers radiation without incisions or cuts.
Open Surgery
| Procedure Name | How it is Performed |
|---|---|
| Microvascular Decompression | The surgeon makes an incision behind the ear. A small hole is then created in the skull to access the trigeminal nerve and the compressing blood vessel. Finally, a pad is placed between the blood vessel and the nerve to relieve pressure. |
Helpful Tips
If you suspect you might have trigeminal neuralgia impacting parts of your face:
- Consult a doctor for an accurate diagnosis and to discuss treatment options for your facial pain.
- Keep track of the following details, as they can assist your doctor in diagnosing your condition related to face pain:
- What type of pain do you experience in your face? (Examples: sharp, electric shock-like, dull, etc.)
- What triggers the facial pain?
- Does the pain in your face follow any pattern? (For example, does it come and go?)
- Where exactly is the pain located on your face?
- How long have you been experiencing this facial pain?
- Is there anything that worsens or alleviates the pain in your face?
Ask questions. Before deciding on a treatment, inquire about how it will help manage your facial pain and ensure you understand the risks involved. Also, ask if the pain might return after treatment and what options are available if it does.
