Trigeminal neuralgia, also known as tic douloureux, is a condition with lancinating facial pain. The pain involves only one side of the face and follows the distribution of the trigeminal nerve. Most often, the pain is caused by compression of the trigeminal nerve by the superior cerebellar artery as the nerve enters the brainstem. Other causes include multiple sclerosis, or rarely tumors located around the trigeminal nerve.
Patients with trigeminal neuralgia have disabling facial pain often described as electrical shocks or sharp stabbing pain. The pain is often triggered by chewing or brushing teeth on that side of the face. The forehead, cheek, or jaw can all be involved, but the pain only affects one side of the face. Motor function of the face is not affected.
Most patients will first be evaluated by their primary care doctor. A referral may be made to see a neurologist. The evaluation will include a detailed history and physical examination. An MRI of the brain will be obtained to rule out an underlying tumor or plaque associated with multiple sclerosis.
The first line of therapy for trigeminal neuralgia is carbamazepine, or Tegretol. Complete or acceptable relief of pain is seen in about 70% of patients. Other medications that are often used include: oxcarbazepine, baclofen, and gabapentin.
In cases where the medications are becoming less effective or the side effects are not tolerated, surgical treatment options are discussed. These possible treatments include microvascular decompression, percutaneous rhizotomy, and stereotactic radiosurgery. The specific treatment is chosen based on patient age, other health problems, location of pain, and history of prior treatments.
Microvascular decompression often offers the best long-term pain relief. This involves a craniotomy where the vessel compressing the trigeminal nerve is identified and moved off of the nerve. Percutaneous rhizotomy involves creating a lesion in the nerve with either radiofrequency energy or with balloon compression. Stereotactic radiosurgery uses high dose radiation therapy to create a lesion in the trigeminal nerve.