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Trigeminal neuralgia

Published by Bupa's health information team, May 2009.

This factsheet is for people who have trigeminal neuralgia, or who would like to know more about it.

Trigeminal neuralgia, also known as 'tic douloureux', is a disorder of the trigeminal nerve that causes intense stabbing, burning or electric shock type facial pain. The pain usually lasts a few seconds and can come and go over time.

About trigeminal neuralgia
Symptoms of trigeminal neuralgia
Causes of trigeminal neuralgia
Diagnosis of trigeminal neuralgia
Treatment of trigeminal neuralgia
Questions and answers
Related topics
Further information
Sources

About trigeminal neuralgia

The trigeminal nerve, also known as the fifth cranial nerve, supplies sensation to the skin of the face and the upper half of the head. It has three divisions, or branches.

Ophthalmic. This is the upper division and runs above the eye, forehead and front of the scalp.
Maxillary. This is the middle division and runs through the cheek, teeth and gums, upper jaw, and side of the nose.
Mandibular. This is the lower division and runs over the lower jaw, teeth and gums.

Trigeminal neuralgia can affect one or more of the divisions. It usually affects the maxillary and the mandibular divisions.

People of any age can get trigeminal neuralgia but it's more common in people over 50 years. Women are more likely to get trigeminal neuralgia. People with multiple sclerosis are more at risk.

Symptoms of trigeminal neuralgia

The pain is normally on one side of the face and can last up to two minutes. It's often very severe and may cause the person to wince. If you have trigeminal neuralgia you may feel a sharp, intense, stabbing pain. The pain may be triggered by the wind, shaving, washing, speaking, chewing or smiling. In very severe cases, the pain may prevent eating or drinking. In this situation, you must see your GP straightaway.

Trigeminal neuralgia occurs in bouts that last for weeks or months. Some people have remission periods where the pain stops for months or years.

Causes of trigeminal neuralgia

Most cases of trigeminal neuralgia are thought to be caused by an artery (blood vessel) pressing on the trigeminal nerve. Occasionally trigeminal neuralgia can result from nerve damage due to multiple sclerosis or other medical conditions. Around one to five in 100 people with multiple sclerosis develop trigeminal neuralgia.

Diagnosis of trigeminal neuralgia

If you think you have trigeminal neuralgia visit your GP. He or she will ask you about your symptoms and examine you. Your GP may also ask you about your medical history. There is no test for trigeminal neuralgia. Your GP will need to rule out a number of other conditions that have similar symptoms including disorders of the jaw, teeth or sinuses. Migraines and cluster headaches also have similar symptoms. Your GP may refer you for a magnetic resonance imaging (MRI) scan.

Treatment of trigeminal neuralgia

Trigeminal neuralgia is usually treated with medicines. Surgery can be performed if there is no improvement with medicine.

Medicines

There are a number of medicines available to treat trigeminal neuralgia. Carbamazepine is the most commonly used medicine. Your GP will prescribe a low dose and increase the dose until the pain is controlled. It will help to reduce the number of attacks and the severity of the pain. You may need to have blood tests if you're prescribed a high dose of carbamazepine to monitor the levels in your blood.

If you're under 50, you have side-effects to carbamazepine, or your symptoms don't improve, your GP will refer you to a neurologist. He or she is a doctor who specialises in conditions that affect the nervous system (including the brain). The neurologist may prescribe a different medicine such as oxcarbazepine, gabapentin or lamotrigine.

Hospital treatment

If your symptoms don't improve after taking medicine, or you have severe side-effects, you will be referred to a neurosurgeon.

There are a number of different types of surgery used to treat trigeminal neuralgia. The aim of the surgery is to block the electrical activity of the nerve that is causing the pain. This can be done by injecting glycerol into the nerve, freezing or heating the nerve, or compressing the nerve using a small balloon. Over nine out of 10 people who have this procedure have short-term pain relief. Pain relief can vary from a few months to several years. You will usually have a feeling of numbness in your face after the procedure.

A procedure called microvascular decompression (MVD) is used if the pain is caused by a blood vessel pressing on the trigeminal nerve. This involves making a hole in the skull and moving the blood vessel away from the nerve. The surgery usually requires a hospital stay of five to 10 days and it's done under general anaesthesia. This means you will be asleep during the operation. As this is a major procedure and carries risk of stroke and deafness, it's only done when other simpler surgical treatments have not completely relieved the pain.

Gamma knife therapy is a non-surgical treatment for trigeminal neuralgia and uses a highly focused beam of radiation to target the nerve. It doesn't require an operation but there are only a small number of hospitals carrying out this procedure in the UK.