Trigeminal Neuralgia

Trigeminal neuralgia is a chronic pain condition that affects the trigeminal nerve, which carries sensation from one side of your face to your brain.

Patients with trigeminal neuralgia typically experience episodes of lightning-bolt pain on one side of the face often triggered by simple activities like chewing, brushing teeth or applying makeup. Jolts of excruciating pain may last seconds to minutes and then stop with pain-free intervals which may last hours or days.

The trigeminal ganglion has 3 divisions: ophthalmic (forehead), maxillary (mid-face) and mandibular (lower jaw). Pain may involve one, two or all three of these divisions.

Atypical Facial Pain

A less common form of the disorder, called atypical facial pain, causes a constant, dull burning or aching pain that is continuous rather than episodic. With atypical facial pain, electric shock-like stabs may occur, worsening the constant and continuous ache. Unlike typical trigeminal neuralgia, there is often not a specific trigger point for the pain, and it can grow worse over time. Both trigeminal neuralgia and atypical facial pain affect one side of the face and are believed to be caused by injury, inflammation or mechanical impingement of the trigeminal ganglion.

Trigeminal Neuralgia and Atypical Facial Pain Treatment Options

As far as treatment, there are various medications including gabapentin, pregabalin and carbamazepine that are sometimes very effective. Some patients also find pain relief with opioids, but narcotic pain pills may lead to addiction.

If there is a demonstrable compression of the trigeminal ganglion by bony growth, tumor or enlarged blood vessel, a neurosurgeon may be able to relieve pain with surgical decompression. There is also a radiosurgery treatment option called gamma knife in which intense, focused radiation is targeted to the trigeminal ganglion.

If surgery fails or is not indicated, the interventional pain physician can help. At Nura, we start with neural blockade of the trigeminal ganglion– a simple and safe procedure in which steroid and local anesthetic is injected near and around the trigeminal ganglion. If nerve block relieves pain short term but does not last, we consider radiofrequency ablation of the trigeminal ganglion, a procedure done with IV sedation or general anesthesia in the interventional pain clinic.

In the most severe cases which fail to respond to medications, injections, nerve ablations, and/or surgeries, targeted drug delivery with an implanted pain pump may be considered.

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