Trigeminal neuralgia, sometimes called tic douloureux, is a chronic condition that affects the trigeminal nerve. You have two trigeminal nerves — one on each side of your face. These nerves transmit pain and other sensations from your face to your brain. Most people with trigeminal neuralgia only have one nerve affected by the condition.
The main cause of trigeminal neuralgia is a blood vessel pressing against one of the trigeminal nerves. Trigeminal neuralgia can also develop due to multiple sclerosis (MS), because MS can damage the nerve’s myelin sheath (a protective coating). In some cases, trigeminal neuralgia can be the result of a brain tumor.
ANATOMY OF THE TRIGEMINAL NERVE
The trigeminal nerve has three branches: ophthalmic, maxillary, and mandibular. The location of your trigeminal neuralgia pain depends on what part of the trigeminal nerve is affected. Most people feel it in the lower part of their face. Severe, recurring facial pain is the main symptom of trigeminal neuralgia. This pain may include sensations of stabbing or electrical shock in the cheek or jaw. Some people mistake the pain as a result of a dental condition and have teeth removed to try to find relief.
Trigeminal neuralgia pain may last a few seconds to a few minutes at a time. Most people have periods of weeks, months, or longer without pain, followed by episodes of several pain attacks over a long period. Some patients may avoid eating, talking, and other trigger behaviors to try to avoid the pain. Unfortunately, trigeminal neuralgia can progress and cause worsening pain that lasts longer.
Most people with trigeminal neuralgia are over 50. However, you can develop the condition at any age. You’re more likely to have trigeminal neuralgia at a younger age if you’ve been diagnosed with MS. Women are also more likely to develop this condition than men.
If you have facial pain but you're not sure if you have trigeminal neuralgia, take our online trigeminal neuralgia risk assessment to learn more. If your answers suggest that you might have trigeminal neuralgia, our neurology team can guide you through next steps including the advanced treatment options available at Baystate Health.
Trigeminal neuralgia treatment
If your diagnosis is trigeminal neuralgia, there are several treatment options to discuss with your neurologist. Your treatment plan likely will start with prescription medications. The medication we use most often to treat trigeminal neuralgia is carbamazepine (Tegretol or Carbatrol). This is part of a class of medications called anticonvulsants, which we use most often to treat seizures. If carbamazepine isn’t a good choice for you, your doctor may recommend another anticonvulsant instead. Your doctor may adjust your dosage until you have the most pain relief with the fewest side effects.
You may become resistant to carbamazepine therapy over time. This can lead to you getting less benefit from the medication even after your doctor increases the dose you take. If this happens, you and your doctor may need to discuss surgical treatment for your trigeminal neuralgia.
SURGICAL TREATMENT OPTIONS
There are several procedures available to treat trigeminal neuralgia if medication therapy is no longer enough or if you’re not a good candidate for it. Microvascular decompression (MVD, also known as the Jannetta procedure) was named after its creator, Dr. Peter J. Jannetta. Dr. Kamal Kalia of Baystate Neurosurgery was trained by Dr. Jannetta himself. “The cure rate for the Jannetta Procedure is 80%, with most patients who come out of surgery touching their face and smiling after feeling not a single jolt of pain,” says Dr. Kalia.
Before this procedure, you’ll have a magnetic resonance imaging (MRI) exam so we can be sure of what is causing your trigeminal neuralgia. In most cases, trigeminal neuralgia is the result of a blood vessel making contact with the trigeminal nerve in the face. If that’s the case, you may be a good candidate for MVD.
You’ll be asleep during MVD surgery. Your surgeon will make a small incision behind the ear on the side of your skull where you experience pain. Next, your surgeon will create a small hole in your skull through that incision. We’ll use a microscope to see inside the incision and locate the blood vessel pressing on your trigeminal nerve. Once we do, we’ll move the blood vessel away from the nerve and use a Teflon pad to keep the vessel from touching the nerve.
We complete MVD surgery in about two hours, and you’ll stay in the hospital for two to three days to recover. Due to our vast experience with this procedure, patients who undergo MVD surgery with us usually have shorter hospital stays and faster recoveries with us versus other providers.
Glycerol rhizotomy is a treatment option we use if your trigeminal neuralgia is the result of multiple sclerosis (MS). We may recommend this procedure if you’re not a good candidate for MVD surgery. Some patients who don’t have MS also choose glycerol rhizotomy because it’s less invasive and doesn’t involve brain surgery.
There are additional treatment options available for trigeminal neuralgia, such as radiosurgery (Gamma Knife), balloon compression, and others. You and your surgeon will work together to decide whether these procedures are right for you if you aren’t a good candidate for either MVD or glycerol rhizotomy.
EXPERT TRIGEMINAL NEURALGIA CARE AT BAYSTATE HEALTH
Trigeminal neuralgia patients come from all over the U.S. and even internationally to be seen and treated by Dr. Kalia at Baystate Health. “The Jannetta Procedure was unique and still is,” Dr. Kalia says. “There are not that many neurosurgeons that Dr. Jannetta trained who are performing the procedure regularly. Some neurosurgeons may do one every other year, but that is not enough to keep them highly skilled in the procedure. And there is only one neurosurgeon in New England other than me who trained under Dr. Jannetta,” he adds.
With that extensive experience and an 80% cure rate for the procedure, Dr. Kalia is helping trigeminal neuralgia patients experience life without facial pain.
If you’re experiencing facial pain, take our trigeminal neuralgia risk assessment and consider contacting our neurology team for a follow up.