Trigeminal Neuralgia

Trigeminal neuralgia is a sudden, severe facial pain which can be described as like having an electric shock in the jaw, teeth or gums.
The attacks happen randomly and almost always affect just one side of the face. They can stop and start suddenly and usually last just a few seconds, but in this time the severity of the pain can be crippling.

Trigeminal Neuralgia is rare and affects less than 1 in 10,000 people per year, women being slightly more commonly affected than men. It is more common in adults over 40 years old, with the majority of cases starting in adults between the ages of 50 and 60.

Trigeminal Neuralgia is normally caused by compression of the trigeminal nerve, most frequently by one of the normal blood vessels at the base of the brain. The trigeminal nerve is a very large and sensitive nerve which transmits sensory information (touch, temperature and pain) from your face to your brain.

Very rarely it can occur due to other conditions such as a benign growth or neurological conditions.

Symptoms include:

• Episodic bouts of pain which can be interspersed by pain free periods
• Sharp/electric pain in the face, most commonly the jaw, teeth or cheek
• Pain brought on by touch to the face or the inside of the mouth

The diagnosis of Trigeminal Neuralgia is made by taking a very careful description of the pain. This can be done by your dentist or GP, recognising that many people visit the dentist first to rule out a dental cause.

Although your GP or dentist may be able to commence appropriate painkillers for this condition, it is recommended that a new diagnosis of Trigeminal Neuralgia should be referred for a specialist opinion (neurologist or neurosurgeon). This allows accurate confirmation of the diagnosis and investigations including an MR scan.

The majority of people with Trigeminal Neuralgia can be safely and effectively managed with specific painkillers. The first-line treatment is a drug called carbamazepine (which is also used as drug to control epilepsy). This can give complete relief although can require adjustment of the dose to find a level where it provides optimum relief with minimal side-effects.

If carbamazepine is ineffectual or has significant side-effects, there are second and third-line medications which can be used. This often requires specialist input from a neurosurgeon or neurologist.

There are several non-medical options that can be used very effectively, either if medication is not working or cannot be tolerated. These include potentially curative operations to relieve the compression of the trigeminal nerve by the causative blood vessel (an operation called a “microvascular decompression”).

There are also other options which cause a small amount of damage to the nerve and this can produce several months or years of pain relief. These include injecting the nerve with a substance called glycerol or targeting the nerve with a very focused beam of radiotherapy (“stereotactic radiosurgery”). These can be discussed in detail with a neurosurgeon who specialises in the management of Trigeminal Neuralgia