Diagnosis
Because trigeminal neuralgia pain can be felt in the jaw, cheeks, or mouth, many people initially consult with their dentist. Dentists are well-placed to examine your mouth and teeth to rule out dental causes of pain. If a dental cause isn’t found, your 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. They will also conduct a physical exam to assess sensation in your face and the strength of your masticatory muscles – the muscles used for chewing.
You might be referred to a specialist for further evaluation. This could be an orofacial pain specialist, who focuses on diagnosing and treating pain in the mouth and face, or a neurologist, a specialist in disorders of the nervous system.
An MRI (magnetic resonance imaging) of the brain may be ordered. An MRI can help determine if a blood vessel is compressing the trigeminal nerve and the severity of the compression. It can also reveal if there’s a secondary cause for your condition.
Diagnosing the precise cause of facial pain can be challenging because numerous conditions can cause similar symptoms. However, pinpointing the source of your pain is crucial for receiving the right treatment.
Treatment
Treatment for trigeminal neuralgia typically starts with medication. When medications are insufficient 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 for better pain control.
The table below outlines some common medication classes used for trigeminal neuralgia treatment:
Medications for Trigeminal Neuralgia
| Medication Class | Examples | Important Information |
|---|---|---|
| Anticonvulsants | Carbamazepine Oxcarbazepine Phenytoin Others | These are usually the first-line medications prescribed by healthcare providers. |
| Muscle Relaxants | Baclofen | Baclofen is particularly helpful for individuals with trigeminal neuralgia secondary to multiple sclerosis. |
| Antidepressants | Amitriptyline Nortriptyline | These tricyclic antidepressants can be used to manage the pain. |
| Neurotoxins | Botulinum Toxin Type A injections | Botulinum toxin type A injections block the release of substances needed for nerve cells to communicate. Current evidence suggests these injections may be beneficial when other medications are ineffective. |
It’s important to ask your healthcare provider about monitoring requirements while taking these medications. Some require regular blood tests to ensure they are not causing adverse effects on your body.
Surgery
Surgery is considered when medication fails to provide relief, side effects are unmanageable, or imaging reveals a blood vessel compressing the trigeminal nerve.
There are two primary types of surgical approaches for trigeminal neuralgia:
- Ablation or controlled lesion procedures, where trigeminal nerve fibers are intentionally damaged to disrupt 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 | Lesion Creation Method |
|---|---|
| Balloon Compression | Pressure exerted by a balloon on the nerve |
| Glycerol Injection | Injection of a thick, colorless liquid called glycerol |
| Radiofrequency Ablation | Heat application |
| Stereotactic Radiosurgery (Gamma Knife, CyberKnife) | Radiation delivery |
Balloon compression, glycerol injection, and radiofrequency ablation can be performed by inserting a small tube or needle through the cheek to deliver the treatment. Radiosurgery uses a specialized machine to deliver radiation without incisions or cuts.
Open Surgery
| Procedure Name | Procedure Description |
|---|---|
| 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:
- Consult a doctor for an accurate diagnosis and to discuss treatment options.
- Keep track of the following details, as they can assist your doctor in diagnosing your condition:
- What kind of pain are you experiencing? (Examples: sharp, electric shock-like, dull, etc.)
- What triggers the pain?
- Does the pain follow a pattern? (e.g., comes and goes in cycles)
- Where is the pain located?
- How long have you had the pain?
- Does anything worsen or alleviate the pain?
Ask questions. Before deciding on a treatment, inquire about how it will help and ensure you understand the potential risks. Also, ask about the possibility of pain recurrence after treatment and the available options if that occurs.
