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Trigeminal Neuralgia (TN)

What is Trigeminal Neuralgia?

Trigeminal neuralgia (TN or tic douloureux) is a chronic neurological condition that affects the trigeminal nerve, the fifth cranial nerve, causing intense facial pain. TN1 is the most common form of the disorder, causing an extreme, burning, or shock-like facial pain that lasts from several seconds to a few minutes per episode. The attacks can occur in quick succession, in events that last as long as two hours. TN2 is characterized by constant aching, burning, stabbing pain of lower intensity than TN1.

An individual may experience both types of trigeminal neuralgia at the same time. Usually only one side of the face is affected. In rare cases both sides of the face may be affected at different times. In very rare cases both sides of the face are affected at the same time, called bilateral TN. The intensity of TN makes it physically and mentally debilitating.

The painful episodes caused by trigeminal neuralgia typically become progressively worse. TN occurs in both men and women, but it is more common in women over the age of 50. The condition is not life-threatening, but can seriously impact quality of life. Many people with TN report symptoms of extreme anxiety and depression because of the severe pain and unpredictability of attacks.

About the host: Dr. Nitin Tandon is a neurosurgeon and professor at the Vivian L. Smith Department of Neurosurgery at UTHealth Houston. View his presentation of the signs, symptoms and treatment options for trigeminal neuralgia (TN).

Causes of Trigeminal Neuralgia

TN is usually caused by a blood vessel pressing on the trigeminal nerve as it leaves the brain stem. TN symptoms can also occur in people with multiple sclerosis, or a nerve injury. In rare cases, TN may be caused by nerve compression from a tumor or an arteriovenous malformation. The trigeminal nerve may also be injured by sinus surgery, oral surgery, facial trauma, or stroke.

Symptoms of Trigeminal Neuralgia and Diagnosis

TN is marked by sudden, severe spasms of stabbing or electric shock-type pain on one side of the face that lasts for several seconds up to a few minutes. The pain often begins around the eye, cheek, or lower part of the face and affects the eyes, jaw, and mouth, which leads many patients to think they have a dental problem. Other symptoms may include numbness, tingling or a burning sensation in the face, and facial contortion.

TN can be triggered by laughing, drinking, chewing, brushing teeth, talking, or touching the face. The onset of a TN episode is unpredictable and followed by a period of time without pain, which usually lessens as the condition progresses. Many individuals avoid social contacts in fear of suffering an attack.

Diagnosis of trigeminal neuralgia is based on medical history, description of symptoms, and physical and neurological exams to rule out other conditions that cause facial pain. Those conditions include nerve pain following an outbreak of shingles, cluster headache, and temporomandibular joint disorder. Diagnosis is difficult because of the large number of conditions that can cause facial pain. Your doctor will ask you to undergo an MRI scan to rule out a tumor or multiple sclerosis and may check your response to a short course of certain medications to reach an accurate diagnosis.

Advanced Treatment of Trigeminal Neuralgia

The most common treatments to relieve trigeminal neuralgia are anticonvulsant medications, used to block nerve firing, and muscle relaxants. If that doesn’t work, or the side effects are too harsh, then a surgery, Microvascular Decompression, or Gamma Knife® stereotactic radiosurgery can alleviate the pain.

Because chronic pain can be isolating and depressing, some patients benefit from supportive counseling or therapy. Others manage TN using complementary techniques such as yoga, visualization, meditation, aromatherapy, acupuncture, biofeedback and nutrition therapy. Botulinum toxin A injections to block the activity of sensory nerves may help relieve pain for some people.

The Face Pain and Headache Clinic at UTHealth Houston Neurosciences brings together a multidisciplinary team of board-certified, fellowship-trained neurosurgeons, neurologists, researchers and pain management specialists who work together to provide relief for even the most complex problems. People who suffer from migraine, cluster headache, trigeminal neuralgia, hemifacial spasm, pineal cyst, and other disorders benefit from collaborative, highly specialized expertise focused on managing chronic headaches and face pain.

What You Can Expect at UTHealth Houston Neurosciences

At UTHealth Houston Neurosciences, neurologists, neurosurgeons, interventional pain management specialists, neuro-oncologists, radiation oncologists, and neuropathologists work together to determine the care each patient needs, discussing treatment options as a group. This approach saves our patients time and money and allows our specialists to share each other’s insights, leading to better treatment decision-making and outcomes.

We first investigate options for nonsurgical treatment, including medical management, pain management, physical therapy, rehabilitation, and watchful waiting. When surgery is needed, our neurosurgeons routinely employ innovative minimally invasive techniques. Throughout the treatment process, our team works closely with the doctor who referred you to ensure a smooth transition back to your regular care plan. While you are with us, you can expect expert care, excellent communication, and genuine compassion.

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Contact Us

At UTHealth Houston Neurosciences, we offer patients access to specialized neurological care at clinics across the greater Houston area. To ask us a question, schedule an appointment, or learn more about us, please call (713) 486-8000, or click below to send us a message. In the event of an emergency, call 911 or go to the nearest Emergency Room.