Trigeminal neuralgia commonly is called “tic douloureux” or just “tic”. When severe, it is the most excruciating pain known to man. This pain most frequently involves the lower lip and lower teeth or the upper lip and cheek, but it also may involve the nose and the area above the eye. The trigeminal nerve provides sensation to the face.
The pain in Trigeminal neuralgia is caused by compression of the trigeminal nerve at the brainstem by an artery or vein. Diagnosis Trigeminal neuralgia is diagnosed based on patient history and physical exam. Patients suspected to have Trigeminal neuralgia undergo an MRI to exclude other causes of facial pain. Treatment Medical therapy is the first line of treatment.
The most effective drug for controlling this pain is Tegretol. Dilantin, Baclofen, and Neurontin are also used to treat trigeminal neuralgia and in some cases patients are managed with multiple medications to improve effectiveness. These medicines are associated with many side effects that are intolerable to some patients. In others, the effectiveness decreases over time. For these patients, medical therapy has failed and they are candidates for one of the surgical treatments of the disease.
Microvascular decompression (MVD)
Surgical procedure performed under general anesthesia. A small window about the size of a quarter is created in skull of the back of the head. A microscope is used to identify the compressing artery (vein) and a pad is placed between the artery and the trigeminal nerve. Surgery is effective in 90% of cases and provides a long term cure in most instances.
Radiofrequency Lesioning (RFL)
Radiofrequency lesioning (RFL) is a minimally invasive outpatient procedure used to treat trigeminal neuralgia. A needle is inserted into the face under local anesthesia and sedation and placed into the affected portion of the nerve.
The RFL needle is then heated to a level which reversibly damages the nerve, producing numbness in the area. The procedure is effective but temporary. Pain usually returns within 18 months, along with sensation. Repeat RFL procedures can be performed.
Radiosurgery
Radiosurgery is another method for treating trigeminal neuralgia. Very high dose radiation is delivered to the trigeminal nerve in an outpatient procedure. It takes several weeks to months for the pain to resolve. It is effective in roughly two thirds of cases. We reserve radiosurgery for patients who are too sick to undergo MVD and who cannot tolerate a radiofrequency procedure.
For additional information, visit the Trigeminal Neuralgia Association website.
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