Trigeminal neuralgia is severe facial pain caused by the 5th cranial nerve(trigeminal nerve). The pain occurs in extreme, short-lived attacks.
Here you will find further information and selected trigeminal neuralgia specialists and centers.
The trigeminal nerve transmits sensory stimuli from the face to the brain. Another function of the nerve is to control the chewing and temporal muscles.
If the trigeminal nerve isirritated or damaged, it causes severe pain. This happens, for example, when the nerve is pinched. Common causes are nearby blood vessels that exert pressure on the cranial nerve. A facial injury can also pinch one of the nerve branches.
The associated discomfort can severely impair the patient's daily routine. The course of facial pain cannot be predicted in advance: some patients are symptom-free for weeks and months. Others complain that the pain attacks become more frequent as the disease progresses.
The likelihood of developing the very painful trigeminal neuralgia increases with age. Nevertheless, this form of facial pain occurs relatively rarely: Every year, around 4 in 100,000 people develop trigeminal neuralgia.
Branching of the trigeminal nerve in the face © Henrie | AdobeStock
Trigeminal neuralgia occurs in attacks: There is sudden, very severe and stabbing pain, which is often limited to one side of the face. The attack lasts from a few seconds to a maximum of two minutes. Even the teeth and nasolabial folds can be affected. The nasolabial folds run from the nose to the mouth.
Such attacks can occur several times a day. The time between attacks of facial pain is without symptoms in most patients. However, some complain of constant pain in the facial area.
The pain is sometimes accompanied by reflex muscle spasms in the affected side of the face. This is why the debilitating condition is also known as tic douloureux.
As the pain attacks are very severe and emotionally stressful, many patients also suffer from depression. For fear of the next attack, many of them even give up eating every day and lose weight.
Patients with these symptoms are best advised to contact their doctor immediately.
The International Headache Society (IHS) distinguishes between classic and symptomatic trigeminal neuralgia in this very rare disease.
The exact cause of the classic form has not yet been medically clarified. Triggers include, for example
are possible causes.
Symptomatic trigeminal neuralgia occurs as a symptom of an underlying disease. This could be, for example
Patients with symptomatic facial pain do not have pain-free episodes. The pain then always occurs on both sides.
The diagnosis is made by the family doctor, as the patient usually consults him first. The neurologist (doctor for nerve diseases) then examines the patient for any underlying disease.
As a rule, he will have a computer tomography(CT) or magnetic resonance imaging(MRI) performed. These imaging procedures are used to detect abnormal findings such as a brain tumor.
If the doctor suspects multiple sclerosis as the cause of the stabbing facial pain, he or she will perform a lumbar puncture: a small amount of cerebrospinal fluid (CSF) is removed from the spinal canal and examined in the laboratory. He also carries out blood tests to clarify other suspected diagnoses.
With the help of MR angiography, the specialist can create a detailed image of the blood vessels. For example, he can check whether there are malformed blood vessels.
If a surgical procedure is necessary, the neurosurgeon can use the images to identify the exact course of the blood vessels in the surgical area.
In the classic form of trigeminal neuralgia without an underlying disease, the doctor usually prescribes medication. These are not painkillers, which have no acute effect. Instead, the condition is treated with medication for epilepsy. They block the conduction of nerve impulses in advance.
The specialist often prescribes medication with the active ingredient carbamazepine. The patient takes higher and higher doses until relief is achieved. Alternatively, oxcarbazepine and baclofen are used. This reduces the hyperexcitability of the fifth cranial nerve.
If the pain is too severe, the patient must take both drugs at the same time. In hospital, the epilepsy drug phenytoin is administered during treatment.
Surgery is only the treatment of choice for this condition if
The neurosurgeon then uses one of three surgical procedures.
He blocks the activity of the nerve nodes using radiosurgery. During this procedure, a high dose of radiation is precisely directed at the surgical area(cyberknife procedure). The rays destroy the nerve fibers near the brain stem. Most patients are symptom-free just one day after treatment.
In some cases, however, it takes two weeks to a maximum of two months before the patient is free of facial pain.
Thermocoagulation can also be used. With this method, extreme heat destroys the nerve fibers.
If a vessel presses on the trigeminal nerve, there is another treatment method. The doctor inserts a small sponge between the blood vessel and the nerve.
Symptomatic trigeminal neuralgia mainly affects younger people. Treatment depends on the disease causing it.
If depression occurs as a result of the intense pain, patients also need psychological help.
Today's surgical methods are sophisticated and high-performance technology is used. In addition, neurosurgeons are highly qualified and experienced. Nevertheless, surgical procedures on the trigeminal nerve can cause permanent damage to health.
These include, for example
In addition, relapses can always occur despite surgery.
In the case of severe nerve pain, a neurologist is the right person to consult. A neurologist is an expert in diseases of the nervous system.
Specialists in neurology are medical doctors who complete 60 months of further training in neurology and psychiatry after completing their studies.
A neurosurgeon can also be an expert in trigeminal neuralgia. His specialty includes surgical interventions in the area of the nervous system.
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