Trigeminal Neuralgia

What is trigeminal neuralgia?

Trigeminal neuralgia (TN) is a problem with your trigeminal nerve that causes severe facial pain. You have a trigeminal nerve on each side of your face. The nerves allow you to feel pain, touch, and temperature changes in different areas of your face.

What causes trigeminal neuralgia?

The exact cause of your TN may not be known. The following can cause the nerve to send pain messages to your brain:

  • Pressure from blood vessels in the head

  • Pressure from a tumor or cyst

  • Injury to the nerve from head trauma, surgery, or a stroke

  • Damage from other diseases, such as multiple sclerosis (MS)

What are the signs and symptoms of trigeminal neuralgia?

TN causes sudden, sharp, or burning pain. It normally occurs on one side of your face but can occur on both sides.

  • Pain attacks that last from 1 second up to 2 minutes and repeat every few minutes to hours

  • Pain attacks that get worse over time

  • Pain that is so severe you cannot eat, drink, or speak

  • Spasms in your facial muscles during your pain attack

  • Days to years without attacks

What can trigger a pain attack?

Most TN pain attacks are brought on by touching a trigger area on your face:

  • Eating or drinking

  • Smiling, yawning, or talking

  • Shaving or washing your face

  • Putting on makeup or combing your hair

  • Wind or temperature changes

  • Noise or lights

How is trigeminal neuralgia diagnosed?

Your caregiver will ask about your symptoms and when they started. Tell him if you have any close family members with TN. Your caregiver will look at your head, neck, mouth, jaws, and teeth. You may also need any of the following tests:

  • CT scan: This is also called a CAT scan. An x-ray machine uses a computer to take pictures of your head. It may be used to look at bones, muscles, and blood vessels. You may be given dye through an IV to help your caregiver see the pictures better. Tell the caregiver if you are allergic to iodine or seafood. You may also be allergic to the dye.

  • MRI: Pictures are taken of your head so caregivers can examine your 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.

  • MRA: MRA is a test used to look at the blood vessels in your brain. This test may show if a blood vessel is pressing on your trigeminal nerve. An MRA may be done with an MRI to help caregivers better understand your TN.

How is trigeminal neuralgia treated?

Your TN may go away on its own without treatment. If your TN is caused by another condition, your caregiver will also treat that condition.

  • Medicines:

    • Anticonvulsants: These control seizures, help prevent pain attacks, and decrease symptoms.

    • Antidepressants: These decrease pain and help prevent depression.

    • Muscle relaxers: When your facial muscles are relaxed, you may be less likely to have pain attacks.

    • Pain medicines: You may be given pain medicines if your facial pain is severe.

  • Procedures: 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.

    • Nerve block: This is an injection 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.

    • Microvascular decompression: This is surgery to separate your trigeminal nerve from the blood vessel pressing on it.

    • Percutaneous procedures: These procedures help control your pain by destroying an area deep in your skull where nerve branches come together. Caregivers will insert a needle and tube through the base of your skull to reach this area.

    • Peripheral techniques: Peripheral techniques are done to block the nerve impulses that cause your pain attacks. Your caregiver may destroy the nerve with alcohol (medicine) injections, or he may freeze the nerve. He may also use surgery to remove part of the nerve.

    • Stereotactic radiosurgery: This is also called Gamma Knife surgery. Radiation beams are used to remove a blood vessel that is pressing on the nerve. You may have some pain relief right away after radiosurgery. It may take at least 1 month before you have decreased pain.

What are the risks of trigeminal neuralgia?

  • Medicines used to treat your TN can cause organ damage. Medicines may not help your TN. Over time, some medicines may stop working. Procedures and surgeries to treat TN can cause facial pain or damage. You may have changes in your vision, hearing, memory, speech, or sense of smell or taste. You may have trouble chewing or get mouth sores. You may get an infection, or have brain and nerve damage, seizures, a stroke, or even death. After treatment with a procedure or surgery, your TN may come back, or you may have 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, and drinking. This may lead to dental problems, poor nutrition, weight loss, and dehydration. You may feel tired, anxious, or depressed.

How can I help manage my trigeminal neuralgia?

  • Keep your medicines nearby: Even if you have not had TN symptoms for a long time, keep your medicine nearby. If your symptoms return, contact your caregiver before you start taking your medicines again.

  • Take your medicines as directed: Do not stop taking your medicines without talking with your caregiver first. You may have a bad reaction if you stop suddenly.

Where can I find more information?

  • Trigeminal Neuralgia Association
    2801 SW Archer Road
    Gainesville , FL 32608
    Phone: 1- 800 - 923-3608
    Web Address: www.tna-support.org

When should I contact my caregiver?

Contact your caregiver if:

  • The medicines you are taking are not decreasing your TN pain.

  • You feel worried or depressed and find it hard to do your daily activities.

  • You have headaches, mouth sores, an upset stomach, or diarrhea.

  • Your TN pain feels worse, different, or moves to another area of your face.

When should I seek immediate help?

Seek care immediately or call 911 if:

  • You have a fever, stiff neck, or develop a rash or peeling skin.

  • You have clear or yellow fluid leaking from your procedure or surgery site.

  • You are feeling so depressed you want to harm yourself.

  • You are confused and cannot think clearly.

  • You are not eating or drinking, and you are losing weight.

  • You have eye pain, eye numbness, or sudden vision or hearing changes.

  • You have sudden dizziness, or problems with movement, weakness, or numbness in your face.

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. 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.

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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