Trigeminal Neuralgia - Symptoms, Causes, Risks & Treatment

Trigeminal neuralgia definition is a neurological condition in which pain originates from the trigeminal nerve. This nerve begins near the top of the ear and branches out toward the eye, cheek, and jaw on each side of the face. Although individuals have trigeminal nerves on both sides, the pain typically affects only one side.

These painful episodes can be triggered by everyday activities such as eating, drinking, or talking. Initially, the pain may occur in sudden attacks lasting just a few seconds. However, these painful episodes can extend to two minutes or longer as the condition progresses.

There are two types of trigeminal neuralgia based on the nature and duration of the pain symptoms. These types are as follows: 

• Type 1 (Typical) Trigeminal Neuralgia: It is characterised by episodes of severe and intense pain all over the face, lasting from a few seconds to two minutes. Though there are periods of no pain in between, the complete attack can continue for up to hours. 

• Type 2 (Atypical) Trigeminal Neuralgia: This type involves a constant burning or aching pain that is less intense but more persistent than typical trigeminal neuralgia. The symptoms are more difficult to control in this form of the condition.

The trigeminal neuralgia symptoms are primarily characterised by extreme, sporadic bursts of facial pain that can be exhausting. The key signs associated with the condition are as follows: 

• Numbness or a tingling sensation in the cheek or jaw 

• Sudden, intense bursts of severe pain 

• Frequent occurrences of aches and pains 

  
  
  

• Brief, sharp shocks of pain that can feel like stabbing or electric 

• Unexpected pain episodes triggered by routine activities

• A persistent burning feeling affecting one side of the face

This condition primarily occurs due to the disruption of the normal functioning of the trigeminal nerve. The following trigeminal neuralgia causes are linked to this condition:

• Trauma: Stroke, physical injury to the face or surgical injuries can sometimes affect this nerve and lead to trigeminal neuralgia.

• Blood Vessel Compression: The primary cause of trigeminal neuralgia is a blood vessel pressing on the trigeminal nerve near the brainstem. This leads to the nerve malfunctioning.

• Multiple Sclerosis: In some cases, the trigeminal neuralgia pathophysiology can be associated with underlying issues like multiple sclerosis. It can lead to deterioration of the myelin sheath of the trigeminal nerve, which can trigger the symptoms of TN.

• Tumours: In some cases, a tumour may be pressing against the trigeminal nerve, causing irritation or compression that results in pain.

Trigeminal Neuralgia Risk Factors

Anyone can develop trigeminal neuralgia. However, certain factors can increase the likelihood of this condition. These risk factors include: 

• Hypertension: Chronic high blood pressure is the only modifiable risk factor that might compress the trigeminal nerve.

• Unhealthy Lifestyle: An unhealthy lifestyle can exacerbate trigeminal neuralgia by increasing inflammation and stress, leading to more frequent and intense pain episodes.

• Age: Trigeminal neuralgia is more commonly diagnosed in people over the age of 50.

• Gender: According to a study by Katheriya et al., 2019, TN is nearly twice as common in women as in men. This can be due to changes in female sex hormones that affect pain perception and nerve function. 

• Family History: The disorder can be hereditary in some cases due to genetic influences on the formation of blood vessels in the brain.

Not all causes of trigeminal neuralgia are completely preventable. However, there are a few strategies that might help reduce the risk or mitigate the severity of the condition:

• Keeping blood pressure within a healthy range alleviates the risk of vascular abnormalities that compress the trigeminal nerve.

• Regular check-ups can help diagnose and manage conditions like multiple sclerosis or tumours that might lead to this condition.

• Minimising facial trauma by using protective gear during high-risk activities like sports can prevent injuries that might cause trigeminal neuralgia. 

• Maintaining a healthy lifestyle, including a balanced diet and regular exercise, can improve overall vascular health.

The diagnosis of Trigeminal Neuralgia involves a combination of tests to accurately identify the condition and its underlying causes. The steps involved in the diagnostic process are as follows:

• Medical History and Symptom Review: The neurosurgeon will ask about the symptoms, including the type, location, and pain triggers.

• Physical and Neurological Examination: These tests help determine the exact location of the pain. They also evaluate whether the symptoms are caused by a compressed nerve or some other condition, like migraines. 

• Imaging Tests: Trigeminal neuralgia radiology tests like MRI can detect any underlying structural issues that might be causing the nerve pain. These may include blood vessel compressions, tumours, or multiple sclerosis.

How to prepare for a doctor consultation? 

Preparing for a neurosurgeon consultation for trigeminal neuralgia involves several steps to ensure patients get the most out of their appointments. Mentioned below are some important tips:

• Keep a detailed record of the symptoms, including the type of pain, its duration, frequency, and any triggers. 

• Prepare medical history, such as previous diagnoses, surgeries, and treatments.

• Bring a list of current medications, including over-the-counter drugs and supplements. 

Questions to Ask the Neurologists

During a consultation about trigeminal neuralgia, asking the right questions can help patients make informed decisions about their care. The following are some questions to consider asking the neurology doctor: 

• What tests will be needed to diagnose my condition?

• What treatment options are available?

• Is there any medicine for trigeminal neuralgia, and what are the side effects? 

• Will I need surgery? 

• Will the treatment last for the rest of my life?

Management of this condition aims to alleviate intense facial pain and improve the quality of life for those affected. Trigeminal neuralgia treatment involves a combination of approaches, which are as follows: 

Medications

This is the first line of treatment for people with TN. Trigeminal neuralgia medication reduces or blocks pain signals sent to the brain. Doctors may prescribe the following drugs: 

• Anticonvulsant drugs

• Tricyclic antidepressants (amitriptyline or nortriptyline, especially used in atypical TN)

• Muscle relaxants

• Botox injections 

Surgery

The trigeminal neuralgia surgery is recommended for those whose condition does not improve with medications.

Surgical management of trigeminal neuralgia treatment options include: 

1. Microvascular Decompression: This invasive procedure involves relocating or removing blood vessels that are compressing the trigeminal nerve. It has a high success rate and can provide pain relief for up to ten years.

2. Stereotactic Radiosurgery: It uses focused radiation to damage the trigeminal nerve and reduce pain signals for about three years.

3. Rhizotomy: The procedure destroys nerve fibres and reduces pain. It is performed through the skin (percutaneous) and includes the following types: 

• Balloon Compression: This involves inflating a small balloon to compress the trigeminal nerve, which provides pain relief for one to two years. 

• Glycerol Injections: The surgeon injects glycerol into the root of the trigeminal nerve. It reduces pain by damaging the nerve fibres. 

• Radiofrequency Thermal Lesioning: This procedure uses heat generated by radiofrequency waves to selectively damage the trigeminal nerve fibres.

Complimentary Therapies

Low-impact exercises to relieve trigeminal neuralgia are generally used in combination with medications. Mentioned below are some more approaches to manage this condition: 

• Yoga 

• Meditation 

• Aromatherapy 

• Acupuncture 

• Biofeedback 

Note: The treatment approach is selected based on the patient’s condition and the treating doctor’s opinion. 

As a neurologist, I've seen the profound impact that trigeminal neuralgia can have on daily life, where even a gentle touch or a soft breeze can trigger excruciating pain. This condition, often called the "suicide disease," is one of the most painful disorders known, caused by irritation or compression of the trigeminal nerve.

But I want you to know that there is hope—modern treatments, from medications to minimally invasive procedures, can offer significant relief. The path to managing this pain can be challenging, but together, we'll explore every option to restore your comfort and dignity. My goal is to help you reclaim the moments that this condition has taken from you with compassion and expert care by your side.

- Dr. Himanshu Champaneri

Neuro Surgeon

MBBS, MS General Surgery

Estimated Cost of Trigeminal Neuralgia Treatment 

The cost of trigeminal neuralgia surgery in India depends on the type of procedure, the hospital, and the city where the surgery is performed. Understanding the financial aspects is vital for patients seeking effective relief from this condition. The table below shows the approximate prices: 

Note: Individuals are advised to consult HexaHealth experts for accurate pricing details. 

Delaying treatment for trigeminal neuralgia can lead to several complications. Without timely intervention, the condition can become progressively worse, making pain management more challenging. The following are some risks associated with postponing the treatment:

• Over time, the pain episodes can become more frequent and severe, significantly impacting the patient’s quality of life.

• Persistent, severe pain can result in anxiety, depression, and other mental health issues. 

• The intense pain can interfere with daily activities, including eating, talking, and facial hygiene, leading to a decline in overall functionality. 

• Prolonged use of pain medications without addressing the underlying cause can lead to adverse side effects, including dizziness and drowsiness. 

When to consult a doctor?

Early consultation with a doctor is crucial for diagnosing trigeminal neuralgia and beginning appropriate treatment. Patients should consult a medical expert if they experience any of the following: 

• Chronic facial discomfort 

• Frequent episodes of pain that occur in rapid succession

• Pain that does not get better with over-the-counter medications

While no specific diet can cure trigeminal neuralgia, certain dietary adjustments can manage symptoms and improve overall health. Some tips for individuals with this condition are as follows:

• Soft Foods: Since chewing can trigger pain, opt for soft or semi-solid foods. Examples include Khichdi, mashed potatoes, yoghurt, and soups. 

• Warm, Not Hot Foods: Very hot or very cold foods can trigger pain. Consume foods and beverages that are warm or at room temperature to avoid triggering a pain episode.

• Avoid Known Triggers: Pay attention to and avoid foods that may cause TN attacks. Some people are prone to them due to caffeine, alcohol, and highly acidic or spicy foods.

• Vitamins and Minerals: To help repair the nerves, patients should take supplements like vitamins B12, D, and C and minerals like zinc, chromium, and selenium.

Trigeminal neuralgia is a serious condition characterised by intense facial pain that can significantly impact daily life. Episodes of severe pain often strike suddenly and can be triggered by activities like eating or speaking. Effective treatment options range from medications to surgery, depending on the severity of the problem. 

HexaHealth offers comprehensive support and guidance for those dealing with this condition. By connecting you with experienced specialists for the surgical treatment of trigeminal neuralgia, we ensure access to the best possible care. Our platform helps streamline the process from diagnosis to recovery, making it easier to find the relief you need.

Also Read:

• Optic Nerve Disorder
• Vagus Nerve Stimulation
• Tips to Repair Damaged Nerves Naturally