What Is Trigeminal Neuralgia?

Trigeminal neuralgia is a chronic pain condition that affects about 12 out of 100,000 people in the United States each year. You may be experiencing sudden, severe face pain that comes and goes without warning — one of the early symptoms of trigeminal neuralgia. It is a symptom that people often mistake for an underlying dental problem. This misdiagnosis could lead to your dentist pulling multiple teeth before you find out what’s really going on. 

Before you schedule another trip to the dentist, make an appointment with one of our neurologists at University of Utah Health, who are experts in recognizing the signs and treating the symptoms of trigeminal neuralgia.

Trigeminal Neuralgia Causes

There are many causes of trigeminal neuralgia, but trigeminal neuralgia is most often caused by a blood vessel compressing a nerve inside your skull. With every beat of your heart, the vessel pulses, pounding on the nerve and sending abnormal signals that you interpret as pain. The causes of trigeminal neuralgia are complex, and we don’t understand exactly why some people are affected and others are not.

Trigeminal neuralgia most frequently affects people older than 50. In fact, the condition is more common in women than men. Research suggests it could also be related to multiple sclerosis, hypertension, and inherited blood disorders.

Trigeminal Neuralgia Symptoms

Pain typically occurs in intermittent bursts that last anywhere from a few seconds to two minutes. Mild stimuli can trigger attacks, such as brushing your teeth or stroking your cheek. The pain of trigeminal neuralgia may become more and more frequent until the pain is almost continuous.

Flare-ups may continue for a few weeks or months followed by a pain-free period that can last a year or more.

Trigeminal Neuralgia Treatment: What to Expect

Your doctor will do a physical exam and conduct a detailed medical history to rule out any other causes for your pain. He or she will want to know when the pain first started, what triggers your flare-ups, and whether you’re also experiencing any numbness or changes in hearing—symptoms that could indicate you have another cause of trigeminal neuralgia, such as multiple sclerosis or—very rarely—a brain tumor. Our doctors understand that talking about your pain can be difficult, especially if you’ve been living with it for a long time.

You should take comfort knowing that there are several options for relief. Our doctors say medication is the best treatment option unless your medication doesn’t work, stops working, or causes severe side effects, in which case you could explore one of the surgical options below.

Trigeminal Neuralgia Surgery

Microvascular Decompression

For this procedure, we use a general anesthesia to put you under, then make a small incision behind your ear. A small hole is created in the skull so we can see the nerve using a high-powered microscope. Then we move the blood vessel that’s compressing the nerve and keep it away from the nerve with padding. This surgery takes us about four to five hours. You should plan on staying one to two nights in the hospital. Microvascular decompression has an approximately 80 percent success rate. Possible complications after microvascular decompression include: 

  • aseptic meningitis, with head and neck stiffness,
  • major neurological problems, including deafness and facial nerve dysfunction,
  • mild sensory loss,
  • cranial nerve palsy, causing double vision, facial weakness, hearing loss, and
  • on very rare occasions, postoperative bleeding and death

Percutaneous Rhizotomy

If you aren’t eligible for microvascular decompression or simply want a less invasive option, percutaneous rhizotomy is a good alternative. For this surgery, we insert a small needle through one cheek and into where the nerve exists in the skull. We then damage the nerve to keep it from sending pain to the brain. We use balloon compression most often to preferentially injure the pain fibers.

In this procedure, we treat the symptoms of trigeminal neuralgia, and not the cause, which means there is a higher chance of the pain returning. That said, about 90 percent of patients find that their facial pain disappears immediately after the balloon procedure. However, unlike microvascular decompression, there is a higher rate of pain returning over time. You can also repeat the procedure, if necessary.

Stereotactic Radiosurgery

Stereotactic radiosurgery (SRS) is the least invasive trigeminal neuralgia surgery. In this case, doctors damage the nerve root with a fine, targeted beam of radiation so it can’t send pain signals to your brain. The surgery takes a few hours and you can go home whenever you feel ready. Unlike percutaneous rhizotomy and microvascular decompression, the beneficial effects of radiosurgery can take weeks or months to kick in. Stereotactic radiosurgery typically causes fewer and milder side effects than conventional radiotherapies, which cover a wider area and can affect healthy tissue. 

Next Steps

If you would like to find out more information about surgery for trigeminal neuralgia, you will need to get a referral. You do this by seeing your primary care doctor or neurologist, and requesting a referral to see a neurosurgeon specializing in the treatment of facial pain.

Chronic pain from trigeminal neuralgia can be incredibly frustrating and you might feel alone. If you’d like to speak with someone about the condition’s mental impact, our team can also connect you with the right support group.