Trigeminal Neuralgia

Trigeminal neuralgia (trigeminal nerve pain) is said to be one of the worst cause of pain that a person can experience. Trigeminal nerve is a paired nerve with center located in the brainstem. Both trigeminal nerves have three main branches and every branch has its endings in the skin of the face. These delicate nerve fibers converge and through small holes they enter depths of the skull. The basic function of a trigeminal nerve is transmitting information of touch and pain sensation from relevant half of face including teeth. In addition it allows controlling some of our chewing muscles.


The underlying cause may be often uncertain and the nerve pain is of unclear origin. However, it was discovered that nerve pain may be related to a too close contact between trigeminal nerve and a nearby blood vessel that can irritate the nerve tissue. There are also other serious causes of neural damage like an aneurysm of cerebral vessels or brain tumors. Trigeminal neuralgia is more frequent in patients with multiple sclerosis, which besides other things leads to disruption of nerve conduction.


Pain is said to be very intense, electrifying, and sometimes even unbearable. Pain sensations starts from the middle of face innervated by corresponding trigeminal nerve. It includes a strong tooth pain, which is especially traumatizing. Such pain attacks usually do not last too long and disappear in a matter of minutes but they unfortunately tend to reoccur. Sometimes the neuralgia is bilateral.


Diagnosis is based on clinical problems. A neurologic examination should be performed. Besides confirming the diagnosis itself it is also preferable to try to find or exclude its primary cause (for example a brain tumor or blood vessel aneurysm).


A variety of drugs is used to counter the symptoms and prevent recurrent attacks – antiepileptics, antidepressants, sedatives etc. Sometimes these medicaments are used in combination with painkillers. The therapy often has a number of side effects but it is usually quite effective in pain relief and reduction in seizure frequency.


Besides medication surgical procedures are sometimes performed. Neurosurgeons operate in the area of trigeminal nerve and try to shift any anatomical structure causing compression of the nerve such as close blood vessels.

Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources