Diagnosis
Because trigeminal neuralgia pain can be felt in the jaw, cheeks, or mouth, many people first consult with a dentist. The dentist can examine your mouth and teeth to rule out dental causes of the pain. If a dental cause isn’t found, the dentist might suggest you see your primary care physician.
Your doctor will review your medical history and ask about your symptoms, including a detailed description of the pain. They will also perform a physical exam to check the sensation in your face and the strength of your masticatory muscles (muscles used for chewing) to see if they are normal.
A specialist in orofacial pain, who diagnoses and treats pain in the mouth and face, or a neurologist, a specialist in nervous system disorders, may also be part of your care team.
You may have a magnetic resonance imaging (MRI) scan of your brain. The MRI can show if a blood vessel is compressing the trigeminal nerve and the extent of the compression. It can also reveal if there is a secondary cause of the disorder.
Because many conditions can cause facial pain, getting a correct diagnosis can sometimes be challenging. However, finding the cause of your pain is crucial so you can receive the right treatment.
Treatment
Treatment for trigeminal neuralgia usually starts with medication. When medications are not enough to control the pain, or when a person cannot tolerate the side effects, surgery may be considered.
Medications
Several medications are available to treat trigeminal neuralgia. These can be used alone or in combination to achieve better pain control.
The table below shows some classes of medications used to treat trigeminal neuralgia:
Medications for Trigeminal Neuralgia
| Drug Class | Examples | Important Information |
|---|---|---|
| Anticonvulsants | Carbamazepine Oxcarbazepine Phenytoin Others |
These are usually the first medications your healthcare provider will offer. |
| Muscle Relaxants | Baclofen | Baclofen is especially helpful for people who have trigeminal neuralgia secondary to multiple sclerosis. |
| Antidepressants | Amitriptyline Nortriptyline |
These tricyclic antidepressants can be used to treat the pain. |
| Neurotoxins | Botulinum toxin type A injections | Botulinum toxin type A injections block the release of substances needed for nerve cells to communicate with each other. Current evidence suggests these injections may help when other medications don’t work. |
Make sure to ask your healthcare provider if you need monitoring while taking these medications. For some of these drugs, regular blood tests are needed to ensure they are not causing unwanted effects on your body.
Surgery
Surgery is considered when medications don’t help, their side effects are too severe, or when imaging shows a blood vessel pressing on the nerve.
There are two main types of surgery for trigeminal neuralgia:
- Ablation or controlled lesion procedures, where trigeminal nerve fibers are deliberately damaged so pain signals are not transmitted, and
- Open surgery, where the trigeminal nerve is separated from the blood vessel pressing on it.
See the tables below for more details.
Surgeries for Trigeminal Neuralgia
Ablation or Controlled Lesion Procedures
| Procedure Name | How is the lesion created? |
|---|---|
| Balloon Compression | With pressure exerted by a balloon on the nerve |
| Glycerol Injection | With a thick, colorless liquid called glycerol |
| Radiofrequency Ablation | With heat |
| Stereotactic Radiosurgery (Gamma Knife, CyberKnife) | With radiation |
Balloon compression, glycerol injection, and radiofrequency ablation can be done by inserting a small tube or needle through your cheek to deliver the treatment. For radiosurgery, a special machine delivers radiation without cuts or incisions.
Open Surgery
| Procedure Name | How is it performed? |
|---|---|
| Microvascular Decompression | The surgeon makes a cut (incision) behind your ear. Then, a small hole is made in the skull to reach the trigeminal nerve and the blood vessel pressing on it. Finally, a pad is placed between the blood vessel and the nerve to relieve the pressure. |
Helpful Tips
If you think you might have trigeminal neuralgia:
- See a doctor for an accurate diagnosis and to discuss treatment options.
- Take note of the following, which can help your doctor diagnose your condition:
- What kind of pain do you feel? (Examples include: sharp, electric-shock-like, dull, etc.)
- What triggers the pain?
- Does the pain have a pattern? (For example, does it come and go?)
- Where is the pain located?
- How long have you had it?
- Is there anything that makes it worse or better?
Ask questions. Before deciding on a treatment, ask how it will help you and make sure you understand the risks. Also ask if the pain might return after treatment and what options are available if that happens.
