Trigeminal Neuralgia

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Introduction

What is trigeminal neuralgia?

Trigeminal neuralgia is a neurological disease in which irritation or pressure on the trigeminal nerve (the fifth cranial nerve exiting the skull) pathway causes a stabbing pain in the cheek, eye, and lower part of the face. The pain is usually located on only one side of the face. In addition to pain, there may be tingling and numbness. Trigeminal neuralgia is more common in people older than 50 years of age, in women, and in people who have multiple sclerosis.

Trigeminal neuralgia commonly results from pressure exerted on the trigeminal nerve by a swollen blood vessel. However, any structure, such as a tumor or swelling that irritates or compresses the trigeminal nerve, may cause trigeminal neuralgia. Risk factors include exposure to chemicals or diseases that impair the nervous system.

The signs and symptoms of trigeminal neuralgia can last from hours to days. However, the duration and course of the disease vary from person to person. Some people with trigeminal neuralgia have symptoms that occur infrequently and are not severe, whereas others may have symptoms that are so severe and frequent that they interfere with normal daily activities.

Fortunately, trigeminal neuralgia can be treated successfully with analgesics (pain medicines) and pain-reducing therapies. In some cases, surgical procedures may be performed to relieve pressure on the trigeminal nerve involved.

Seek immediate medical care (call 911), if you, or someone you are with, experience serious symptoms, such as double or blurred vision; confusion or loss of consciousness for even a brief moment; sudden weakness on one side of the body; or numbness or tingling in the arms or legs, as these may be signs of stroke.

Seek prompt medical care if you are being treated for trigeminal neuralgia, but your symptoms recur or are persistent.

Symptoms

What are the symptoms of trigeminal neuralgia?

Trigeminal neuralgia causes pain that can be severe in the area supplied by the trigeminal nerve of the face. The symptoms vary in intensity from person to person. Everyday activities such as chewing or brushing teeth can precipitate an attack of the pain.

Common symptoms of trigeminal neuralgia

You may experience trigeminal neuralgia symptoms daily or just once in a while. At times, any of these symptoms of trigeminal neuralgia can be severe:

  • Numbness in the facial area

  • Pain that resembles a stabbing or burning sensation in the facial area

  • Pain with touch, pressure or movement of the facial area

  • Sensitive skin in the facial area

  • Severe pain when performing normal activities (brushing teeth, chewing, drinking, eating, or shaving)

Serious symptoms that might indicate a life-threatening condition

In some cases, symptoms of trigeminal neuralgia can indicate a life-threatening stroke. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

Causes

What causes trigeminal neuralgia?

Trigeminal neuralgia has various causes, but in some cases the cause is not known. The most common cause is pressure exerted on the trigeminal nerve from a nearby blood vessel. Other possible causes are injury resulting in inflammation and damage to the trigeminal region, ultimately causing nerve irritation and pain. Less commonly, trigeminal neuralgia may result from impingement, entrapment or “pinching” of the nerve root in the neck, sometimes associated with pressure from a tumor. Trigeminal neuralgia also is associated with multiple sclerosis due to damage of the myelin sheath (protective lining around the nerve).

What are the risk factors for trigeminal neuralgia?

A number of factors can increase your risk of developing trigeminal neuralgia. Not all people with risk factors will get trigeminal neuralgia. Risk factors for trigeminal neuralgia include:

  • Advanced age (older than 50 years)
  • Family history of facial pain or trigeminal neuralgia
  • Female gender
  • Head trauma
  • Multiple sclerosis

Attacks of trigeminal neuralgia may be triggered by certain activities including:

  • Applying makeup
  • Blowing your nose
  • Brushing your teeth
  • Chewing gum
  • Drinking hot or cold beverages
  • Eating
  • Shaving
  • Talking
  • Touching your face
  • Washing
Treatments

How is trigeminal neuralgia treated?

Treatment for trigeminal neuralgia begins with seeking medical care from your health care provider. To determine if you have trigeminal neuralgia, your health care provider may ask you to undergo diagnostic tests and provide blood samples for laboratory tests.

Pain-relieving medications (such as analgesics) may be effective for reducing your pain. It is important to follow your treatment plan for trigeminal neuralgia precisely and to take all medications as instructed. Topical creams containing capsaicin may be used at the pain site.

Over-the-counter pain control medications for trigeminal neuralgia

For mild nerve pain, over-the-counter pain medications may be prescribed including:

  • Acetaminophen (Tylenol)
  • Aspirin
  • Ibuprofen (Advil, Motrin)
  • Naproxen (Aleve)

Prescription pain-control medications for trigeminal neuralgia

If your pain is not relieved by over-the-counter medicines, your health care provider may recommend prescription pain medications, which should be used with caution. Medications that contain opiates (such as codeine) may not be effective and are physically addicting, leading to dependence.

Anti-seizure medications that are effective in treating trigeminal neuralgia include:

  • Carbamazepine (Tegretol)
  • Gabapentin (Neurontin)
  • Phenytoin (Dilantin)
  • Pregabalin (Lyrica)
  • Topiramate (Topamax)

Additional options for treating trigeminal neuralgia include antidepressants such as amitriptyline (Elavil), nortriptyline (Pamelor), and duloxetine (Cymbalta). Less common treatments include nerve block or injections of pain-relieving drugs to the pain site. Surgical treatment is used occasionally and may consist of ablation via different methods to decrease pain sensation in the trigeminal nerve. Ablation involves removal of tissue or abnormal growths that are contributing to the pain.

Complementary treatments

Some complementary treatments may help some people better deal with trigeminal neuralgia. These treatments, sometimes referred to as alternative therapies, are used in conjunction with traditional medical treatments. Complementary treatments are not meant to substitute for traditional medical care. Be sure to notify your doctor if you are consuming nutritional supplements or homeopathic (nonprescription) remedies as they may interact with the prescribed medical therapy.

Complementary treatments may include:

  • Acupuncture

  • Biofeedback

  • Hypnosis

  • Massage therapy

  • Nutritional dietary supplements, herbal remedies, tea beverages, and similar products

  • Yoga

What are the potential complications of trigeminal neuralgia?

Left untreated, complications of trigeminal neuralgia can be serious or even life threatening. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of trigeminal neuralgia include:

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2016 Nov 26
  1. Trigeminal neuralgia. FamilyDoctor.org. http://familydoctor.org/online/famdocen/home/common/brain/disorders/940.html.
  2. Trigeminal neuralgia. PubMed Health, a service of the NLM from the NIH. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001751/.
  3. Zakrzewska JM, Akram H. Neurosurgical interventions for the treatment of classical trigeminal neuralgia. Cochrane Database Syst Rev 2011; :CD007312.
  4. Peter, C, Watson, N. Trigeminal neuropathy and neuralgia. In: Neurological therapeutics: Principles and practice, Noseworthy, JH (Ed), London: Martin Dunitz, 2003. p.1849.
  5. Domino FJ (Ed.) Five Minute Clinical Consult. Philadelphia: Lippincott Williams & Wilkins, 2013.'
  6. Tierney LM Jr., Saint S, Whooley MA (Eds.) Current Essentials of Medicine (4th ed.). New York: McGraw-Hill, 2011.
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