Trigeminal Neuralgia: Hope for Debilitating Face Pain

Imagine face pain so debilitating, you’d let a surgeon drill a hole into your skull and pull out a nerve. That was the treatment for trigeminal neuralgia pioneered in the 1890s by neurosurgeon Sir Victor Horsley. 

If you didn’t bleed to death or get an infection, it actually had a good success rate. The procedure also advanced medical knowledge of a condition that left patients so hopeless, it was once called the “suicide disease.” 

Today, neurosurgeons offer much better options for this exquisitely painful condition which is diagnosed in 150,000 people each year.*

Difficult Diagnosis

The electric shock-like, jabbing or shooting pain of trigeminal neuralgia is caused by a disruption of the trigeminal nerve, the sensory nerve for the skin of the face. The pain can last a few seconds or a few minutes and is triggered by touching the face, eating, drinking or talking. Some have constant aching or a burning sensation. 

The condition is generally caused by the compression of the trigeminal nerve. What causes the compression and disruption of the nerve varies. It can occur as you age or result from multiple sclerosis, a brain lesion or tumor compressing the nerve, surgical injury, stroke or facial trauma.

The condition is often confused with tooth pain and I’ve seen patients who’ve had several teeth pulled before receiving the correct diagnosis. An MRI is often part of the diagnostic process to rule out other causes, along with physical and neurological exams. 

Treatment Options

Not everyone with trigeminal neuralgia needs surgical treatment. We generally try antiseizure medications first to calm the nerves. Most people will respond well to that initially. But as with any kind of nerve problem, the body can compensate and the pain can return or increase -- or the nerve can get progressively worse. Various treatments uses may include:

• Rhizotomy - Fibers within the trigeminal nerve are destroyed using a small probe that is placed inside the cheek through the bottom of the skull. This outpatient procedure is generally done under general anesthesia. 
• Microvascular decompression - Tiny padding is placed between the blood vessel and the nerve during this surgical procedure. It typically requires an overnight hospital stay. The 10-year success rate is around 70 percent. This was developed in the 1960s by a neurosurgeon named Peter Jannetta, MD.
• Stereotactic radiosurgery - The trigeminal nerve is damaged with high doses of radiation in this outpatient procedure. It takes an average of three months to be effective and has a 65% long-term success rate. 

While trigeminal neuralgia is an extremely difficult condition, it is no longer hopeless. There are good treatment options. The first step is an accurate diagnosis. Then we can weigh the different treatments based on your condition and preferences. 

For more information reach out to our CHI Health Neurology team.

Resources:

*https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Trigeminal-Neuralgia#