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Trigeminal Neuralgia: Expert Care Offers Relief

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Posted by Willard S. Kasoff, MD, MPH

As a neurosurgeon, I've seen first-hand the effects that facial pain, such as trigeminal neuralgia, can have on people. For my patients who live with these conditions, the simple acts of smiling, talking or eating may trigger intense, unbearable facial pain.

The good news is that effective, life-changing treatments are available. My patients tell me that the condition affects their lives in every area, from work to family. And when even a breeze or light touch to the face can cause extreme pain, it’s no surprise that my patients tell me that trigeminal neuralgia impacts their moods, relationships, and jobs.

When I explain trigeminal neuralgia to a new patient, they are relieved to finally know what’s causing their pain. In addition to dealing with the pain itself, many have experienced intense stress and anxiety as they searched for an accurate diagnosis.

Because the condition is rare and the causes of facial pain can be complex, I see patients who have visited an eye doctor (ophthalmologist) or dentist, and sometimes many other doctors. Some patients may have had other treatments, such as extensive dental work, to try to treat pain.

That’s why I wish everyone knew the basics about trigeminal neuralgia — and why it’s crucial to seek treatment from a neurologist or neurosurgeon, doctors with specialized knowledge of facial pain.

Understanding trigeminal neuralgia

Trigeminal neuralgia is a pain disorder caused by signals from the trigeminal nerve, a nerve that carries sensory signals from the face to the brain. It is also responsible for moving the chewing muscles.

The trigeminal nerves carry sensation from the forehead and the eye; the cheek, nose, and upper lip, teeth, and upper gums; and the jaw and lower lip, teeth, and lower gums.

When one of the trigeminal nerves becomes compressed or irritated, it may begin to trigger intense pain attacks — trigeminal neuralgia (TN). These attacks may be mild or occasional at first, but they tend to become more severe and frequent over time. When a person has trigeminal neuralgia, typically one or two areas on one side of the face is affected.

Other patients with TN or other kinds of facial pain first developed pain after a dental procedure, shingles, surgery, or other injury to the face.

Experts don't fully understand what causes trigeminal nerve pain. Many patients say that their TN pain seemed to occur out of the blue. In those cases, the nerve is often compressed by a nearby blood vessel. Other times, the nerve can be affected by a tumor, conditions like multiple sclerosis or shingles, or facial injuries, including those caused by sinus or oral surgery.

Symptoms of trigeminal neuralgia

TN attacks come and go quickly, although they may happen very often. For most patients, the sensation lasts from less than a second to as long as two minutes. For some, each pain attack may last up to 10 minutes. And most patients tell me that they’ve had episodes in which pain attacks occur repeatedly over the course of one to two hours. These short bursts of pain often feel like an electric shock. Some people describe the feeling as being stabbed in the face by an ice pick, and many say it’s more severe than passing a kidney stone or even giving birth!

Patients with other kinds of facial pain may have a wide range of other types of pain, including burning, throbbing, aching or dull pain. This can be in the area of an injury or be more widespread. This type of pain may have attacks that last longer, up to many hours, or even be constant.

Even mild touch to the face can trigger the trigeminal nerve to misfire and cause an attack. My patients often tell me that their pain has multiple triggers, usually involving light touch to their forehead, cheek, chin, jaw or gums. Common triggers include:

  • Brushing teeth
  • Chewing
  • Drinking a hot or cold drink
  • Feeling a light breeze
  • Putting on makeup
  • Shaving
  • Smiling
  • Talking
  • Touching the face
  • Washing the face

Pain episodes also occur with no obvious trigger. Most of my patients report a mix of triggered and untriggered attacks.

The rate and timing of the pain episodes can vary, and patients often share that wondering when the next attack will come leaves them feeling anxious and on edge — and makes it difficult for them to make plans or enjoy activities.

Treating trigeminal neuralgia

Treatment for TN can reduce or eliminate pain episodes — a life-changing improvement for people living with the condition.

Medications are usually my first-line approach, and many patients will have relief with medication. When medicine isn’t doing enough, surgery can be another choice that may provide a lot of relief.


Because the pain associated with TN occurs in such short episodes, pain relievers aren’t typically an effective approach. Instead, I focus on prescribing medicine with the goal of preventing the episodes: medications such as carbamazepine (Tegretol), oxcarbazepine (Trileptal), gabapentin (Neurontin), or baclofen, can block the trigeminal nerve from firing and stop or reduce attacks.

The downside is that the medications can cause side effects like nausea, confusion, dizziness, or double vision. They may also become less effective over time, resulting in a person needing higher doses and, in turn, experiencing more severe side effects.

Gamma Knife surgery

Despite the name of the therapy, this surgery does not require any incision. During this procedure, also called stereotactic radiosurgery (SRS), a neurosurgeon directs a focused dose of radiation to the root of the trigeminal nerve. The radiation damages the nerve, which can reduce or eliminate facial pain within a few weeks to a few months.

Gamma Knife treatment is a non-invasive, low-risk outpatient procedure with no “down time” needed for recovery. Many patients will experience significant relief, but about half will have pain that comes back within three to five years. If that happens, the procedure can sometimes be repeated. Gamma Knife treatment can often cause some facial numbness.


Using a needle that’s inserted through the face, a surgeon directs a mild electrical current or inflates a small balloon to damage the trigeminal nerve, blocking pain signals. Rhizotomy is performed under anesthesia on an outpatient basis.

Rhizotomy works very quickly and is very effective; however, many patients have pain return within three to five years. The procedure can also cause some temporary facial numbness.

Microvascular decompression

While Gamma Knife radiation and rhizotomy ease pain by damaging the trigeminal nerve, microvascular decompression involves removing or relocating the blood vessels that are touching the trigeminal nerve. This takes the pressure off of the nerve, making it less sensitive.

Microvascular decompression is the most successful TN surgery. About two-thirds of people experience permanent relief; others remain pain-free for many years. It’s also the most invasive option — after their surgery, most patients spend a few days in the hospital followed by about two to four weeks recovering at home. And though it's generally very safe, the procedure comes with a small risk of hearing loss, facial weakness or numbness, double vision, stroke, or death.

Nerve stimulation

For some kinds of facial pain, particularly pain that is constant and not the sudden or electric-shock type, “nerve pacemakers” can be a very helpful tool in managing pain. These devices consist of thin wires (usually placed just under the skin in the face and sometimes within the head or spine) that are connected to a pacemaker and can block or decrease pain. This is a minimally-invasive surgical option that can be tested at home before being placed permanently.

Expert care can be life-changing

Many people with trigeminal nerve pain aren’t sure where to seek treatment. There are also many possible causes of facial pain. As a result, patients may spend time and money seeking help, while continuing to cope with their condition. It’s very important to see an experienced team that can make the right diagnosis and that has all the medical and surgical tools available for each patient.

In addition, untreated TN often worsens over time, so a delayed diagnosis may mean increased pain.

At the Temple Neurosciences Center, our patients benefit from a multidisciplinary team of experts. Our team approach means that it’s simple to consult specialists from a variety of fields as needed. And our advanced technology and leading-edge procedures allow me to recommend a full array of treatment options.

If you’re living with facial pain that could be trigeminal neuralgia, help is available. To schedule your consultation with a Temple neurologist, call 800-TEMPLE-MED (800-836-7536) or request an appointment online.

Willard S. Kasoff, MD, MPH

Dr. Kasoff is a neurosurgeon at the Temple Neurosciences Center. He strives to apply the latest technology, medical evidence and experience to surgery for complex diseases of brain function, including epilepsy, movement disorders and pain.

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