Trigeminal neuralgia: causes and treatments

It affects only one half of the face, and can last even a few seconds, but leaves you breathless for the intensity of the pain. This is trigeminal neuralgia, a disorder of one of the nerves of the face that can cause serious discomfort. But thanks to drugs and surgery, you can try to treat it effectively.

A sudden pain

The trigeminal is the fifth pair of cranial nerves and is divided into three branches: the ophthalmic, which reaches the eye area, the maxilla and the mandibular that control the maxilla and mandible respectively. In addition to being responsible for the sensitivity of the face, teeth, mouth and nose cavity, the trigeminal nerve also controls the movement of the muscles involved in chewing.

“Trigeminal neuralgia manifests itself with sudden and stabbing pain in the face, similar to an electric shock or, more rarely, to a twinge, involving only half of the face,” explains Professor Oriano Mecarelli, of the Department of Neurology and Psychiatry, Sapienza University of Rome. “The most affected parts are the cheek or jaw and the pain rarely reaches the eye area.”

Attacks can be spontaneous or appear with simple movements, such as shaving, brushing teeth, talking, chewing or yawning, and can last from a few seconds to a few minutes, while seizures can go on for weeks. Those who are more unfortunate, on the other hand, do not have a moment’s respite: crises follow one another uninterruptedly even for weeks and attacks last hours.

The diagnosis is made like this

“One of the causes could be an abnormal contact between the nerve and an artery: the blood vessel runs inside the posterior cranial fossa near the trigeminal,” the specialist continues. “When blood flows, arterial pulsation irritates the nerve. Diagnosis is clinical, linked to descriptions of symptoms. However, especially in young people under 40, it is good to do an MRI and a CT scan of the brain, to exclude other pathologies, such as demyelinating diseases or space-occupying lesions.

When medication is needed

The pain is treated with drugs that control electrical discharges and, therefore, also those of the trigeminal. The most commonly used are carbamazepine, oxcarbazepine, gabapentin, pregabalin, phenytoin, valproic acid and lamotrigine. If the drugs are not effective, surgery is performed.

Surgical interventions

“Percutaneous techniques are the fastest interventions and are done under local anesthesia,” warns the specialist. “Anesthetic substances are injected or radio frequencies are used that can cancel the perception of pain. They are especially suitable for the elderly and for those who do not find indication for greater treatment”.

Decompression is instead an invasive intervention that solves the problem thoroughly, canceling the compression of the nerve by the blood vessel, responsible for the pain. It is performed under general anesthesia, involves a small opening of the braincase and the liberation of the nerve from compression.

“Microvascular decompression is a recent technique, done in specialized centers with the help of an endoscope,” says the neurologist. “A thin probe is inserted through a small hole made in the skull, to visualize the nerve and its relationships, and intervene precisely with two advantages: a reduced risk/benefit ratio and a smaller scar.”

A further possibility of treatment is stereotactic radiosurgery: a very concentrated dose of radiation is sent only to the trigeminal nerve, in order to eliminate pain.