What is Trigeminal Neuralgia?

Trigeminal Neuralgia Explained by Las Vegas, Summerlin, and Henderson Nevada’s Top Pain Doctors

Trigeminal Neuralgia skullTrigeminal neuralgia is the medical definition of pain associated with the trigeminal nerve or its branches. This important nervous tissue mainly serves the facial area. The exact cause of trigeminal neuralgia is not clear, but it may be associated with damage or injury to the trigeminal nerves, or its roots in the brain.

The pain associated with trigeminal neuralgia often includes migraines, excruciatingly painful headaches felt usually behind or above one eye. Over time, the pain may spread to other areas of the face, especially if left untreated. The vast majority of migraines occur on only one side of the head. Those associated with trigeminal neuralgia are often episodic, which means they occur with distressing regularity, sometimes as often as once a day at roughly the same time. It is estimated that over 16% of adults in the U.S. suffer from migraines. This type of headache tends to be more prevalent in women of 18 to 44 years than in men. The pain associated with trigeminal neuralgia may also be accompanied by sensitivity to light and/or sound, nausea, or vomiting. Based on patient reports, some scientists regard trigeminal neuralgia as the worst pain known to humanity.

Causes of Trigeminal Neuralgia

Trigeminal GanglionDamage to the trigeminal nerves, or to the trigeminal nucleus located deep in the brain, may be the root of this syndrome. Trigeminal neuralgia can also be caused by facial injury. Migraines are also associated with inflammation to the trigeminal nerve or its branches. Some autoimmune diseases such as multiple sclerosis, lupus, or scleroderma cause this. It is also a result of herpes zoster (shingles), which is a viral infection that attacks nervous tissue and results in chronic pain.

There is also a theory that trigeminal neuralgia is a disorder that causes the protective layers around the nerves to deteriorate over time. This may explain those cases in which there is no other apparent reason for the condition.

Treatment for Trigeminal Neuralgia

As the cause of trigeminal neuralgia is often inflammation, medications that prevent this are often used in migraine treatments. Non-steroid anti-inflammatory drugs (NSAIDs, e.g. naproxen or aspirin) are a common first-line treatment, but they are most effective in people with episodic migraines who suffer from headaches on ten days of every month or less. NSAIDs increase the risk of organ failure if they are taken constantly over a prolonged period. As it is common medical advice to increase a dose of medication in response to the onset of migraine, this risk with NSAIDs is magnified in migraine sufferers. Acetaminophen in high doses is also effective in treating mild migraines.

Opioids are drugs that activate their receptors in the spinal cord to inhibit pain signals. Common examples of opioids include morphine, codeine, and fentanyl. These are often prescribed to patients with severe trigeminal neuralgia. Opioids are an effective treatment, but are associated with the risks of addiction and drug tolerance. Patients taking opioids for migraine may find their symptoms are much worse if they suddenly stop using them.

Carbamezapine is an anticonvulsant often prescribed for episodic migraine. They are effective, but can have severe side effects. These include skin irritation, toxic epidermal necrolysis, and allergic reactions. These reactions damage the skin and organs, and are more prevalent in those of Asian origin.

RadioFrequency Ablation - XRAYThe trigeminal nerve branches merge into a single cluster of nerves located in an area behind the eyes. This cluster, called the trigeminal, Gasserian, or semilunar ganglion, can be a target of minimally invasive surgical treatments. These alleviate severe pain in cases that do not respond to less aggressive treatments. One of these is radiofrequency ablation (RFA). This procedure is done by way of thin probes inserted through the nasal cavity or mouth to reach the ganglion. The area is treated with a local anesthetic at the start of the operation. The ganglion is located with imaging techniques such as fluoroscopy or MRI, and the probe is inserted. Once at the ganglion, it emits electro-thermal impulses that selectively destroys the nervous tissue responsible for pain signaling.

RFA achieves immediate and long-lasting pain relief in up to 97% of migraine patients. There are risks associated with the procedure, however. These are most often infection and discomfort at the probe insertion site, and the possibility of reduced motor control or sensation in the facial area. Some patients report extreme pain caused by insertion of the probe, even after local anesthesia.

Conclusion

Trigeminal neuralgia is a condition affecting the trigeminal nerves that supply sensation to the face. It results in migraines, which are extremely painful headaches, radiating from above or around the eye. These migraines are recurrent or episodic. Migraines are often reported as the worst pain that can be experienced.

Treatments for trigeminal neuralgia include drugs such as opioids and NSAIDs. These can cause problems, such as adverse reactions that include organ damage and drug tolerance. If migraines are resistant to these, slightly invasive procedures may achieve more effective and long-term pain relief. An example of this is radiofrequency ablation, in which electro-thermal probes destroy regions of the trigeminal ganglion responsible for transmitting pain signals. This technique can treat migraine in approximately 97% of patients.

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