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Trigeminal neuralgia is a medical condition most commonly found amongst middle-aged and elderly people. It is a condition which causes a sharp pain in the face – and sometimes in and around the gums, which can lead to people to often mistaking trigeminal neuralgia for an ordinary toothache.

The trigeminal nerve is the fifth cranial nerve. It is responsible for motor functions such as chewing and transmitting sensations from the face to the brain. People have 12 pairs of cranial nerves in total, and each pair emerges directly from the brain. The trigeminal nerve reports all facial sensations, including temperature and direct physical contact. If anything interferes with the normal functions of the trigeminal nerve, it can result in a range of abnormal symptoms known as trigeminal neuralgia.

The most common cause of trigeminal neuralgia is when a blood vessel moves too close to the trigeminal nerve, and begins to strike or press against it. In turn, this compression causes the trigeminal nerve to function abnormally and to become more sensitive to stimulation than usual. The nerve may also become inflamed due to multiple sclerosis.

Patients with Trigeminal neuralgia will experience a sharp pain in the face similar to an electric shock, or pain in and around the gums, causing people to often mistake it for an ordinary toothache. Symptoms of trigeminal neuralgia show up periodically, but are more likely to occur during physical contact with the face such as when washing one's face, brushing one's teeth, shaving, or even when in windy weather.

In diagnosing trigeminal neuralgia, the doctor will examine the patient's medical history in detail, and may also perform a brain scan using magnetic resonance imaging (MRI). This allows the doctor to distinguish trigeminal neuralgia from other conditions which cause similar symptoms.

Medication: In the first stage of treatment, the doctor will normally prescribe anticonvulsantmedication to help alleviate the pain. However, this method of treatment does not combat the root cause of the condition. Additionally, if the patient's symptoms do not respond to the anticonvulsant medication, the doctor may consider an alternative treatment.
Surgery: The doctor may perform surgery to reposition the blood vessel that is pressing on the trigeminal nerve. This operation, known as a microvascular decompression (MVD), combats the root cause of the trigeminal neuralgia. MVD involves opening the skull and inserting a sponge between the nerve and offending artery or vein causing the pain. It is successful in relieving symptoms for 80-85% of patients. However, as with any type of surgery, there is the risk of further complications developing, such as infection or bleeding during the operation. The major benefit of MVD is that it causes little or no facial numbness compared to other methods.
Radiation: This type of treatment aims to damage the trapped nerve, in order to numb the affected area. However, in some cases the pain may reoccur spontaneously, a condition otherwise known as anesthesia dolorosa.

Created When: 五月 16, 2019

Last modify: 九月 25, 2020

Bumrungrad Hospital

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