The name trigeminal neuralgia is derived from:
- Trigeminal - the name of the affected nerve located near the brain
- Neuralgia - pain that comes from a nerve
The pain can be triggered by simple actions such as eating, brushing teeth, or even talking.The pain arises from the trigeminal nerve usually because it is compressed by a blood vessel, although other causes such as tumours or multiple sclerosis must be excluded.
- The diagnosis of trigeminal neuralgia is based on history and neurological examination.
- Imaging such as MRI may be required to exclude other causes.
The first-line treatment of trigeminal neuralgia is with medications. For many patients, the pain can be controlled or reduced with medication and the appropriate specialised care.
When should additional treatment be considered?
- Pain that is not well controlled despite the best use of medications
- Intolerable side-effects from these medications (commonly sleepiness, dizziness, forgetfulness)
- Patients who do not wish to be on lifelong medications
There are three main options, each with their own advantages and risks:
- Microvascular decompression
- Percutaneous lesioning
Each of these surgical treatments has their roles.
1. Microvascular decompression
The most commonly performed surgical procedure is microvascular decompression as it is potentially curative (>90% initial rate of pain control, 80% long-term). It is also considered an invasive procedure as it aims to fix the underlying problem, namely the compression of the nerve by a blood vessel.
Radiosurgery is the least invasive treatment and uses controlled beams of radiation to target the nerve. The aim is to stop the transmission of pain signals but does not deal with the underlying cause. Therefore, the pain control is often not as effective as microvascular decompression.
3. Percutaneous lesioning
Percutaneous lesioning uses a fine needle to heat the nerve. Similar to radiosurgery, it aims to stop the transmission of pain signals but is again less effective.
An important thing to remember is that the severe disabling pain of trigeminal neuralgia is treatable. With an individualised treatment plan developed after detailed assessment and discussion, effective treatment of trigeminal neuralgia is possible.