Trigeminal Neuralgia

WHAT YOU SHOULD KNOW:

• Trigeminal neuralgia (TN), or tic douloureux, is when a problem with your trigeminal nerve causes severe (very bad) facial pain. You have a trigeminal nerve on each side of your face, and each nerve has three branches. Each nerve branch allows you to feel sensations, such as pain, touch, and temperature changes in different areas of your face. The trigeminal nerve also helps with eating functions, such as biting, chewing, and swallowing. The facial pain with TN can occur in one, two, or all three of the nerve branch areas. TN pain normally only occurs on one side of your face but can occur on both sides. TN causes sudden, sharp, burning, or shock-like pain attacks in the area linked to the problem nerve branch. TN attacks are normally brought on by triggers including eating, talking, shaving, brushing your teeth, wind, and noise.
  
  
• Most attacks occur during the day and may last from less than one second up to two minutes. You may have repeat attacks for minutes to hours. The repeat attacks may occur from weeks to months to years, and often get worse over time. TN pain attacks may occur more often and be more painful as you age. TN may be caused by a blood vessel or tumor (growth) pressing on your trigeminal nerve. This pressure may damage the nerve and cause it to send wrong impulses (messages) to your brain, leading to facial pain. TN may also be caused by multiple sclerosis, an injury, or a stroke. Your risk for TN increases if you are older than 50, female, or have a close family member with TN.
  
  
• You will need a physical exam and imaging tests, such as an MRI, to diagnose your TN. TN may go away on its own, or you may need treatment to decrease or resolve your pain. Treatments include medicines, or procedures and surgeries to block or destroy the problem nerve area. Your caregiver may also suggest alternative treatment options, such as meditation and acupuncture. Treating your TN may help decrease your pain and the number of attacks you have. Treatment may help you return to your normal daily activities.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• Medicines used to treat your TN may cause an allergic reaction including a skin rash and trouble breathing. Some medicines may cause nausea (upset stomach), diarrhea (watery bowel movements), loss of appetite, and weight loss. You may feel dizzy, off balance, drowsy, weak, confused, or nervous while taking some medicines. You may have headaches, vision changes, or problems with your eye movements. TN medicines may cause swelling in your ankles and feet, low levels of body salt, and liver problems. Medicines may not help your TN. Over time, some medicines may stop working and your symptoms may return.
  
  
• Procedures and surgeries to treat TN may cause facial pain and discomfort, weakness, numbness, tingling, bruising, or swelling. They may cause eye numbness, pain, dryness, swelling, or tearing. You may have changes in your vision, hearing, memory, speech, sense of smell or taste, or trouble chewing. You may get mouth sores or an infection, such as meningitis (swelling of the covering of your brain and spinal cord). Cerebrospinal fluid (CSF) from your brain may leak out of your procedure or surgery site. You may also be at risk for brain and nerve damage, seizures, stroke, or even death. After treatment with a procedure or surgery, your TN may come back, or you may have a new TN pain.
  
  
• If your TN is not treated, your pain attacks may get worse and occur more often. If a growth or other medical problem is causing your TN pain, you may not get proper treatment. You may begin to have a dull, constant ache in areas of your face. Your TN pain, and fear of an attack, may be so bad that you stop brushing your teeth, eating, drinking, and speaking. This may lead to dental problems, poor nutrition, weight loss, and dehydration (loss of body water). You may feel tired, anxious (nervous), and you may become depressed (deep sadness). You may not want to be around others and find it hard to do your daily activities, such as work. If your depression gets severe, you may think of hurting or killing yourself. Talk with your caregiver if you have questions or concerns about your condition, treatment, or care.

WHILE YOU ARE HERE:

Informed consent:

A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

IV:

An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.

Medicines:

• Anticonvulsants: Anticonvulsants are medicines given to control seizures. These medicines may be used to help prevent TN pain attacks and decrease your TN symptoms.
  
  
• Antidepressants: Antidepressant medicines may be given to help decrease your pain and help prevent depression (deep sadness).
  
  
• Muscle relaxers: Muscle relaxers are medicines to help relax your muscles. When your facial muscles are relaxed, you may be less likely to have pain attacks.
  
  
• Nerve block: A nerve block is a shot of medicine that makes you lose feeling in an area of your body. You may need a nerve block if your pain is not going away, or is getting worse. A nerve block may also be used to make you lose feeling in an area before a procedure is done.
  
  
• Pain medicines: You may be given pain medicines to help decrease your facial pain.

Tests:

• Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
  
  
• Computerized tomography scan: A computerized tomography (CT) scan is a special x-ray machine that uses a computer to take pictures of your brain. It may be used to look at bones, muscles, brain tissue, and blood vessels. You may be given dye before the pictures are taken. The dye is normally given in your IV (a small tube in your blood vessel). The dye may help your caregiver see the pictures better. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may be allergic to some dyes. Tell the caregiver if you are allergic to shellfish, or have other allergies or medical conditions.
  
  
• Magnetic resonance imaging: During magnetic resonance imaging (MRI), pictures are taken of your head. MRIs may be used to look at your brain and trigeminal nerve. You will need to lie still during an MRI. Never enter the MRI room with any metal objects. This can cause serious injury.
  
  
• Magnetic resonance angiography: Magnetic resonance angiography (MRA) is a test used to look at the blood vessels in your brain. This test may show the location of the blood vessel that is pressing on your trigeminal nerve. An MRA may be done together with an MRI to help your caregiver better plan your TN treatment.

Treatment Options:

You may need a procedure or surgery to treat your TN if it does not get better with medicines. A procedure or surgery may also be needed if you cannot take the medicines used to treat TN. Ask your caregiver for more information about these and other procedures or surgeries done to treat TN:

• Microvascular decompression: Microvascular decompression is surgery to separate your trigeminal nerve from the blood vessel pressing on it.
  
  
• Percutaneous procedures: Percutaneous procedures are done to destroy an area of the trigeminal ganglion to help control your pain. The trigeminal ganglion is the area where each nerve branch comes together. The trigeminal ganglion is reached by inserting a needle and tube through your foramen ovale. Your foramen ovale is a hole at the bottom of your skull that nerves pass through. Percutaneous procedures are also called percutaneous rhizotomies. Ask your caregiver for more information about the following:
  
  
  • Balloon compression: During this procedure, a very small balloon is inserted through the foramen ovale and inflated. Once the balloon is inflated, it presses on the trigeminal ganglion and helps decrease or stop your TN pain.
    
    
  • Glycerol injection: During this procedure, glycerol is injected into your trigeminal ganglion to block the nerve impulses and decrease your symptoms.
    
    
  • Radiofrequency thermocoagulation: During radiofrequency thermocoagulation, electric impulses are used to make changes in your trigeminal nerve. This treatment is done so your trigeminal nerve will stop sending pain messages to your brain.
  
  
• Peripheral techniques: Peripheral techniques are done to block the impulses from your trigeminal nerve that cause your TN pain attacks. They may also be done to destroy the area of your trigeminal nerve that is causing your symptoms. Peripheral techniques include the following:
  
  
  • Alcohol injection: During this treatment, alcohol (medicine) is given as a shot into the area of your trigeminal nerve that is causing your symptoms.
    
    
  • Cryotherapy: For cryotherapy, an area of your trigeminal nerve is frozen.
    
    
  • Neurectomy: During a neurectomy, the damaged part of your trigeminal nerve is cut and removed.
  
  
• Stereotactic radiosurgery: During stereotactic radiosurgery, or Gamma Knife surgery, radiation beams are directed at an area of your trigeminal nerve. The radiation beams may help remove a blood vessel that is pressing on the nerve. You may have some pain relief right away after radiosurgery. It may also take at least one month before you have decreased TN pain.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Trigeminal Neuralgia (Inpatient Care)