Trigeminal neuralgia

What is trigeminal neuralgia?

Trigeminal neuralgia is a disease that causes facial pain, characterized by an “electric shock” type, limited to the distribution of one or more branches of the trigeminal nerve. This nerve is responsible for facial sensitivity. Although its prevalence is low (0.3%), it is one of the most frequent neuralgias in the neurology office and predominantly affects middle-aged women. When the trigeminal nerve is irritated or compressed, it can cause episodes of acute pain, with the following characteristics:

• Very intense: sharp and short, lasting seconds.
• Generally limited to one side of the face, in areas such as the cheek, jaw, teeth, nose or less frequently the eyes.
• Triggered by everyday activities such as talking, chewing, brushing teeth, shaving, smiling or even touching the face. The pain is often spontaneous.

What causes trigeminal neuralgia?

Depending on the cause, trigeminal neuralgia is classified into:

• Classic trigeminal neuralgia, caused by compression of the nerve due to a tortuous vessel. It is the most frequent form (75% of cases).
• Secondary trigeminal neuralgia, which represents 15% of trigeminal neuralgia and is due to an underlying disease (tumors, multiple sclerosis, vascular malformations…).
• Idiopathic trigeminal neuralgia, in which there are no alterations in neurophysiological tests or magnetic resonance imaging.

How is trigeminal neuralgia diagnosed?

The diagnosis is made mainly through the symptoms described by the patient during the consultation; on the characteristics of the pain, its duration, intensity, location and factors that trigger it. The neurologist will perform a neurological examination, with special attention to facial sensitivity and the identification of trigger points, which are areas on the face that trigger pain on palpation. In addition, a cranial MRI will be performed with specific sequences to detect if there is compression of the nerve by a vessel or by other lesions.

How is trigeminal neuralgia treated?

Neuromodulatory drugs such as carbamazepine, gabapentin or lamotrigine, among others, are used to control pain. In classic trigeminal neuralgia, if the pain is very intense and does not respond to medication, surgical treatment by means of microvascular decompression is indicated. In other patients, other interventions such as thermocoagulation, balloon compression (Mullan technique), gangliolysis or Gammaknife radiosurgery can be performed.

What can I do?

If you experience recurrent, severe pain in your face, especially if it is associated with everyday activities such as eating or talking, it is important to consult a neurologist. Trigeminal neuralgia is treatable, and most people can find relief with proper treatment.