Trigeminal Neuralgia

What is this condition?

Trigeminal neuralgia causes brief, severe electric-shock pain on one side of the face. Light touch, washing, shaving, talking, chewing or wind can trigger attacks. It is different from constant toothache, sinus pressure or burning facial neuropathy. Classical disease often results from a blood vessel pressing on the trigeminal nerve near the brainstem, but multiple sclerosis, tumour and other causes must be considered.

What symptoms can it cause?

• Short repeated electric-shock attacks in one or more facial divisions
• Trigger zones with pain-free periods between attacks
• Eating and oral hygiene may become difficult
• Constant numbness, weakness, hearing loss or bilateral pain suggests another cause

How is it assessed and diagnosed?

Diagnosis is clinical but MRI with attention to the trigeminal nerve excludes tumour, multiple sclerosis and other structural causes and may show vascular contact. Dental and ENT assessment is useful when the pattern is atypical. Response to medicine supports but does not prove diagnosis.

Treatment without surgery

First-line treatment is usually a nerve-stabilising medicine such as carbamazepine or oxcarbazepine, selected and monitored by a clinician. Blood count, liver or sodium monitoring may be needed. Other medicines can be added. Ordinary painkillers often work poorly because attacks are very brief. Nutrition and dental care need support when fear of eating is severe.

When is surgery or a procedure considered?

A procedure is considered when diagnosis is secure and medicine fails, causes unacceptable side effects or loses effect. Microvascular decompression separates the vessel from the nerve and aims to preserve sensation. Percutaneous radiofrequency lesioning, balloon compression or glycerol intentionally injure selected pain fibres and usually cause some numbness. Stereotactic radiosurgery is non-incisional but relief may be delayed.

Treatment and procedure options

• Optimised medication with monitoring
• Microvascular decompression
• Percutaneous radiofrequency lesioning
• Balloon compression or glycerol rhizolysis in selected cases
• Stereotactic radiosurgery

Risks from the disease and from treatment

Uncontrolled pain can cause dehydration, weight loss, depression and severe loss of quality of life. Procedures may cause facial numbness, corneal anaesthesia/eye injury, dysaesthesia, recurrence, hearing or balance problems, CSF leak, bleeding or stroke depending on method. Anaesthesia dolorosa is uncommon but serious. No procedure is risk-free. General risks include anaesthetic problems, bleeding, infection, blood clots and delayed healing. Neurological risks depend strongly on the exact structure being treated and may include new weakness, numbness, speech or vision change, seizure, cerebrospinal-fluid leakage, need for another procedure or failure to obtain the hoped-for relief. The surgeon should discuss the risks that apply to the individual case.

Recovery and follow-up

Medication is usually reduced gradually only after stable relief. Facial sensation and eye protection are checked after destructive procedures. Recurrence can occur after any treatment, and future options depend on the first procedure and current anatomy. Recovery is not judged only by the first few days. Pain control, wound care, nutrition, safe mobilisation, physiotherapy and planned follow-up all matter. Some symptoms improve quickly after pressure is relieved; others recover gradually over weeks or months, and permanent nerve injury may not fully reverse.

Preparing for your consultation

Bring the original MRI/CT images or digital files, written reports, previous prescriptions, a current medicine list, and any operative or pathology records. For sudden warning symptoms, use the nearest emergency department rather than waiting for a routine appointment.

Authoritative patient-information sources

• AANS — Trigeminal Neuralgia: https://www.aans.org/patients/conditions-treatments/trigeminal-neuralgia/