Trigeminal Neuralgia – Dr Aditya gupta

What is Trigeminal Neuralgia?

Trigeminal Neuralgia (TN) is a chronic pain condition that affects the trigeminal nerve, which carries sensation from the face to the brain. People with this condition experience sudden, severe, electric shock-like pain in the face, typically on one side.

The pain is often triggered by simple activities like talking, chewing, or even touching the face. Trigeminal Neuralgia is one of the most painful neurological conditions and can severely affect daily life.

Causes of Trigeminal Neuralgia

Trigeminal Neuralgia occurs when the trigeminal nerve is compressed, irritated, or damaged. Some common causes include:

Blood Vessel Compression (Most Common Cause)
A nearby artery or vein presses against the trigeminal nerve, leading to irritation and abnormal nerve signaling.
This compression damages the protective covering (myelin sheath) of the nerve, making it hypersensitive.
Multiple Sclerosis (MS) and Other Neurological Disorders
In diseases like Multiple Sclerosis, the immune system attacks the myelin sheath, leading to nerve dysfunction.
Tumors and Cysts
A tumor or cyst in the brain can press on the trigeminal nerve, causing pain.
Facial Trauma or Surgical Injury
Injury from accidents, dental procedures, or surgeries near the face or jaw may damage the trigeminal nerve.
Infections or Inflammation
Shingles (Herpes Zoster), sinus infections, or other inflammations can irritate the nerve.
Unknown Causes (Idiopathic Trigeminal Neuralgia)
In some cases, no clear cause is found, but the pain persists.

Symptoms of Trigeminal Neuralgia

The hallmark symptom of Trigeminal Neuralgia is intense facial pain. The symptoms can vary in severity and duration.

Type of Pain
Sudden, severe, stabbing, or electric shock-like pain.
Typically lasts from a few seconds to two minutes per episode.
Episodes can be spontaneous or triggered by simple activities.
Location of Pain
Usually affects one side of the face.
Most commonly felt in the cheek, jaw, teeth, gums, lips, or side of the nose.
Less commonly, the forehead or around the eye is affected.
Triggers for Pain
Light touch or even wind blowing on the face.
Talking, chewing, swallowing, brushing teeth, or shaving.
Applying makeup, washing the face, or smiling.
Pain Frequency
Episodes may occur in rapid succession (several times a day) or be separated by pain-free periods.
Over time, pain attacks may become more frequent and intense.
Additional Symptoms
Muscle twitching or spasms in the face.
Increased sensitivity in the affected area.
Over time, fear of pain may lead to difficulty eating or speaking.

Types of Trigeminal Neuralgia

There are two main types of Trigeminal Neuralgia:

Classical (Primary) Trigeminal Neuralgia
Caused by blood vessel compression on the nerve.
Sudden and severe pain attacks, usually without numbness.
Secondary Trigeminal Neuralgia
Caused by tumors, multiple sclerosis, or other conditions affecting the trigeminal nerve.
Pain is often less sudden but more constant and burning.

Diagnosis of Trigeminal Neuralgia

Since no single test can confirm TN, doctors use a combination of medical history, physical examination, and imaging studies.

Clinical Evaluation
The doctor asks about pain characteristics, triggers, and location.
Neurological tests are performed to check for nerve function and sensitivity.
Magnetic Resonance Imaging (MRI)
An MRI scan helps detect any tumors, blood vessel compression, or multiple sclerosis lesions affecting the nerve.
High-Resolution MRI with Trigeminal Protocol
A special MRI technique that provides detailed images of the trigeminal nerve and surrounding blood vessels.
Nerve Conduction Studies
Helps differentiate Trigeminal Neuralgia from other neuropathic pain conditions.

Treatment Options for Trigeminal Neuralgia

Treatment focuses on pain relief and improving quality of life. Options include medications, injections, and surgery.

Medications (First-Line Treatment)
Medications help reduce nerve hyperactivity and pain intensity.
a) Anticonvulsants (Most Commonly Used Drugs)
Carbamazepine (Tegretol) – Most effective medication for TN.
Oxcarbazepine, Gabapentin, and Pregabalin – Alternative options with fewer side effects.
b) Muscle Relaxants
Baclofen may be used alone or in combination with anticonvulsants.
c) Antidepressants
Amitriptyline or Duloxetine can help if the pain is persistent and does not respond to anticonvulsants.
Minimally Invasive Procedures
If medications are ineffective, minimally invasive procedures may provide relief.
a) Glycerol Rhizotomy
A chemical injection blocks pain signals in the trigeminal nerve.
b) Radiofrequency Ablation
A heat-generated procedure selectively damages the overactive pain fibers in the nerve.
c) Balloon Compression
A small balloon is inserted to compress the trigeminal nerve and block pain signals.
Surgical Treatment Options
For patients who do not respond to medications or minimally invasive procedures, surgery may be required.
a) Microvascular Decompression (MVD) – Most Effective Surgery
The blood vessel pressing on the trigeminal nerve is repositioned, relieving pressure and pain.
Offers the highest long-term success rate, with 70-90% of patients experiencing lasting relief.
Requires brain surgery, but preserves nerve function.
b) Stereotactic Radiosurgery (Gamma Knife)
A highly focused radiation beam is directed at the trigeminal nerve to disrupt pain signals.
Non-invasive, but pain relief may take weeks to months.
Effective in 70-80% of cases, but may need repeat treatment.
c) Nerve Cutting (Neurectomy) – Last Resort
The trigeminal nerve is surgically cut to stop pain signals permanently.
Used only in severe, untreatable cases, as it may cause permanent facial numbness.
Prognosis and Long-Term Outlook
The course of Trigeminal Neuralgia varies by patient:
✔ Medications work well in early stages, but their effectiveness may decrease over time.
✔ Surgical procedures offer long-term relief, but may have risks.
✔ If untreated, pain episodes may become more frequent and severe.

Early diagnosis and treatment significantly improve the chances of pain control and quality of life.

Complications of Trigeminal Neuralgia

If left untreated, TN can lead to:

Severe weight loss and malnutrition due to difficulty eating.
Depression and anxiety from chronic pain.
Social withdrawal and reduced quality of life.
Prevention and Lifestyle Management

Although TN cannot always be prevented, some strategies may help:
✔ Avoid known triggers (cold wind, spicy foods, or excessive chewing).
✔ Manage stress through yoga, meditation, or relaxation techniques.
✔ Maintain good oral hygiene and avoid unnecessary dental procedures.
✔ Seek early medical intervention if pain worsens.

Dr. Aditya Gupta offers advanced treatments, including surgery and radiosurgery, to effectively manage trigeminal neuralgia and improve the quality of life for patients.