About Trigeminal Neuralgia
What You Should Know About Trigeminal Neuralgia
The sharp facial pain of trigeminal neuralgia (also known as tic douloureux) usually arises from pressure on the trigeminal nerve caused by a blood vessel, usually the superior cerebellar artery.
- Other causes are tumor and multiple sclerosis, injury/damage to a nerve or lack of protective insulation of trigeminal nerve.
- About four in 100,000 people experience trigeminal neuralgia per year, and the condition is most common in males.
Symptoms
- Symptoms consist of intermittent shooting pain on one side of the face emanating from one or more branches of the trigeminal nerve.
- Symptoms, which last a few seconds, may be set off by chewing, swallowing, talking or other sensory stimulation the face.
Diagnosis
- Medical history and physical examination are key to diagnosing trigeminal neuralgia. The history should determine the following:
- An accurate description of pain localization to determine which divisions of trigeminal nerve are affected
- Determine the time of onset and what triggers the pain
- Determine what medications and dosages of medication have been tried
- Determine history of herpetic vesicles
- A magnetic resonance imaging (MRI) of the brain is used to rule out the possibility of tumor.
Treatment
- The first line of treatment is medication.
- The drug of choice is carbamazepine (Tegretol™), which eliminates or brings acceptable pain relief in 69 percent of patients.
- Baclofen (Lioresal™) is the second drug of choice and may be more effective if used with low-dose carbamazepine.
- Other medications that may be effective include pimozide, phenytoin (Dilantin™), capsaicin, clonazepam (Klonopin™) and amitriptyline (Elavil™).
Meet Our Experts Who Treat Trigeminal Neuralgia
Won Kim, MD Assistant Professor
Dr. Kim completed his neurosurgical residency training at UCLA with a fellowship in stereotactic and functional neurosurgery. His clinical interests include the treatment of primary and metastatic brain tumors deep within the brain using a wide variety of surgical modalities to best suit each individual patient and tumor type.
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Surgical procedures
- Percutaneous trigeminal radiofrequency rhizotomy
- This procedure selectively destroys pain-causing nerve fibers while preserving touch fibers.
- Lesioning techniques include radiofrequency thermocoagulation, glycerol injection and mechanical trauma. They are used for patients who are poor candidates for major surgery.
- Complications can include weakness in chewing, facial numbness, changes in tearing or salivation and, less often, corneal ulcers, severe aching pain (anesthesia dolorosa) or meningitis.
- Microvascular decompression of the trigeminal nerve
- This surgical technique involves microsurgery to move the vessel, causing compression away from the trigeminal nerve.
- Relief is often long lived; however the incidence of facial numbness is much less than in selective rhizotomy and anesthesia dolorosa does not occur.
- The procedure is best for patients younger than 65 with no significant medical or surgical risk factors.
- Possible complications include asceptic meningitis, with head and neck stiffness; major neurological problems, including deafness and facial nerve dysfunction; mild sensory loss; cranial nerve palsy, causing double vision, facial weakness, hearing loss; and, on very rare occasions, postoperative bleeding and death.
- Microvascular decompression brings complete relief to 75 percent to 80 percent of patients. The recurrence rate is 5 percent to 17 percent.
- Glycerol injection
- This treatment is similar to that for radiofrequency rhizotomy. A needle is inserted in the region of the trigeminal ganglion, and glycerol (a colorless fatty liquid used in many food and skin products) is deposited nearby.
- Results of this procedure are less predictable because after the glycerol is injected its location cannot be controlled precisely.
- Although 80 percent of patients treated with glycerol initially experience respite from trigeminal neuralgia, more than half of these experience a return of the pain within five years after surgery.
- A small degree of numbness in the area of the pain remains after the procedure.
- Balloon compression
- This treatment is based on older treatments for trigeminal neuralgia consisting of massage or partial injury of the trigeminal nerve.
- A small balloon is passed through a catheter (narrow tube) into the skull to the location of the trigeminal ganglion. There it is inflated, and compression causes partial injury to the trigeminal ganglion.
- Pain is no longer transmitted to the brain, so the trigeminal neuralgia is, in effect, blocked.
- Because this procedure is new, results are less known and few surgeons are using this method.
- Stereotactic Radiosurgery
- The treatment involves focusing radiation on the trigeminal nerve. The radiation will cause injury to the nerve preventing it from transmitting the pain.
- There are different machines available to perform this procedure, including Gamma Knife, X-Knife, Cyberknife and Novalis. UCLA uses Novalis. This machine is able to shape the beam to the shape of the target.
- The success of this procedure is 90 percent to 95 percent with few side effects.
The Neuro-ICU cares for patients with all types of neurosurgical and neurological injuries, including stroke, brain hemorrhage, trauma and tumors. We work in close cooperation with your surgeon or medical doctor with whom you have had initial contact. Together with the surgeon or medical doctor, the Neuro-ICU attending physician and team members direct your family member's care while in the ICU. The Neuro-ICU team consists of the bedside nurses, nurse practitioners, physicians in specialty training (Fellows) and attending physicians. UCLA Neuro ICU Family Guide
