Trigeminal Neuralgia: A Guide to Managing Facial Pain

Imagine a sudden, intense jolt of pain that feels like an electrical shock shooting through one side of your face. This is the harsh reality for people living with trigeminal neuralgia, a rare and excruciating nerve disorder that disrupts daily life with unpredictable waves of pain.

While the exact number is unknown, researchers estimate that about 15,000 cases of trigeminal neuralgia are diagnosed every year in the United States, says UNC Health neurosurgeon Sivakumar Jaikumar, MD.

We talked to Dr. Jaikumar to learn more about trigeminal neuralgia, its symptoms and the available treatments for managing its impact.

What Is Trigeminal Neuralgia?

Trigeminal neuralgia is a chronic pain condition that affects one of the body’s 12 cranial nerves, known as the trigeminal nerve. This nerve is responsible for providing sensation to the face and is divided into three branches: ophthalmic, maxillary and mandibular.

“Trigeminal neuralgia is characterized by severe, often debilitating facial pain, typically affecting one or two of these branches,” Dr. Jaikumar says. “It is usually unilateral, meaning it affects only one side of the face, and is rarely bilateral.”

The pain associated with trigeminal neuralgia is described as sharp, shooting and like an electrical shock. The pain can last for a few seconds to a few minutes, and it can be triggered by activities such as brushing your teeth, touching your face, eating or even the wind blowing on your face.

Trigeminal Neuralgia Symptoms and Diagnosis

The primary symptom of trigeminal neuralgia is sudden, severe facial pain. The pain can be so intense that it disrupts your daily activities and significantly affects your quality of life.

Trigeminal neuralgia is sometimes hard to diagnose.

“Patients may initially seek help from dentists, mistaking the pain for a dental issue, which can lead to extensive and unnecessary dental work before the correct diagnosis is made,” Dr. Jaikumar says. “The diagnosis is often based on a detailed patient history and the characteristic pain pattern.”

You will usually need a CT or MRI scan to rule out other conditions that can cause similar symptoms, such as a tumor or multiple sclerosis, an infection from herpes, trauma, or temporomandibular joint (TMJ) disorders.

Treatment Options for Trigeminal Neuralgia

Treating trigeminal neuralgia often begins with medications.

“Anticonvulsants such as carbamazepine, gabapentin and pregabalin are commonly used to manage the pain. Muscle relaxants like baclofen and in some cases Botox injections or steroids may also be prescribed,” Dr. Jaikumar says.

However, people on these medications will need their liver and platelet function monitored regularly. Some medications may not be safe for women who are pregnant or planning to have a baby, due to potential risks to the developing fetus.

If medications do not relieve your symptoms, your doctor may recommend more advanced treatment options. These include nerve blocks, where numbing medications are injected near the affected nerve to help block pain signals.

Other treatment options include:

  • Balloon compression, a surgical procedure in which a balloon is used to gently press against the trigeminal nerve to relieve pain
  • Glycerol injections into the trigeminal nerve using a special X-ray for guidance, which helps calm down the nerve fibers that cause pain to try to reduce discomfort
  • Radio-frequency ablation, a surgical technique that directs high-frequency heat at the trigeminal nerve, destroying its ability to transmit pain signals to your brain

“These treatments are aimed at reducing pain signals in the affected nerve pathways,” Dr. Jaikumar says.

If your trigeminal neuralgia is caused by a blood vessel pressing on the nerve, a surgery called microvascular decompression, or MVD, can be an option.

“During MVD, a surgeon relieves the pressure on the nerve by placing a small Teflon pad between the nerve and the compressing blood vessel. This procedure is more suited for younger patients who can tolerate surgery and offers longer-lasting pain relief,” Dr. Jaikumar says.

Radiation therapy is another option for people who are not candidates for surgery or who have not found relief from other treatments. This involves targeting the trigeminal nerve with precise, high-dose radiation to reduce pain, although it may take several weeks for this treatment to be effective, Dr. Jaikumar says.

Living with Trigeminal Neuralgia

Managing trigeminal neuralgia involves a combination of medical treatment and lifestyle adjustments.

Stress management is crucial, as stress and anxiety can make the condition worse,” Dr. Jaikumar says. “Avoid known triggers and maintain a healthy lifestyle to prevent malnutrition and weight loss, which can occur if the pain makes eating difficult.”

Getting treatment early is crucial for effectively managing trigeminal neuralgia. Once you are diagnosed, your primary care doctor can usually handle your initial treatment with medication, but you may need a referral to a neurologist or neurosurgeon for further evaluation and advanced treatment options.

Trigeminal neuralgia is a painful and challenging condition, but with proper diagnosis and a comprehensive treatment plan, you can achieve significant relief and improve your quality of life.

“We don’t know the root cause of it, so we don’t know how to prevent it,” Dr. Jaikumar says, “but ongoing research continues to enhance our understanding and management of this complex condition, offering hope for better outcomes for those affected.”

If you’re suffering from debilitating pain, talk to your doctor. Need a doctor? Find one near you.