Diagnosis and Treatment of Trigeminal Nerve Pain
What is Trigeminal Nerve Pain?
The trigeminal nerve is one of the 12 cranial nerves within the central nervous system responsible for sensation, including pain and touch in the face and mouth. Abnormal sensations of pain originating from the trigeminal nerve may be trigeminal neuralgia, which can have a major impact on a patient’s quality of life.
Trigeminal neuralgia pain may be “shooting” or “stabbing” in character and can last for different periods of time, from seconds to hours, and may happen frequently or infrequently. The pain can be the result of a damaged, compressed or irritated nerve, facial trauma, a recent dental procedure, a tumor or intracranial abnormalities. Most pain has a root cause, which an oral and maxillofacial surgeon (OMS) can help determine.
Medical History and Physical Examination
An OMS can take a detailed medical history to understand your symptoms and their patterns. A physical examination may also be performed – focusing on the affected areas of the face – to identify any visible signs or triggers. Triggers may include speaking, chewing, brushing teeth or simply touching the face.
Symptom Assessment
Accurately describing your symptoms to your OMS is important. Be sure to describe the character of the pain (sharp, electrical, throbbing, etc.), its frequency, duration and any triggers. Providing this information can help your OMS effectively assess and diagnose your condition.
Diagnostic Imaging
In some cases, your OMS may order imaging procedures such as magnetic resonance imaging (MRI) or computed tomography (CT). These tests can help visualize the structures of the head and face and identify possible causes of trigeminal nerve pain, such as tumors or vascular compression.
Treatment Options for Trigeminal Nerve Pain
An OMS may recommend one or more treatment options to help alleviate your trigeminal nerve pain.
Medications
Medication is often the first line of treatment for trigeminal nerve pain. Your OMS may prescribe:
- Anticonvulsants: These can be prescribed to help reduce nerve impulses and control pain signals. Commonly prescribed anticonvulsants include carbamazepine, gabapentin and pregabalin.
- Muscle relaxants: These medications relax facial muscles to prevent muscle spasms and their associated pain.
- Neurotoxin injections (e.g., Botox): Studies have shown that injections of Botox (botulinum toxin type A) into the trigeminal ganglion can be helpful in reducing trigeminal nerve pain for several weeks up to several months.
Nerve Blocks
Nerve blocks involve injecting a medication – such as a local anesthetic or corticosteroid – into specific branches of the trigeminal nerve to temporarily block pain signals. Nerve blocks can provide immediate pain relief and help identify the cause of pain. They are not a “cure” and usually wear off after a few days, weeks or months, depending on the patient.
Surgical Intervention
Surgical intervention may be considered when medications or nerve blocks are ineffective. Surgery options include:
Microvascular Decompression
Microvascular decompression is an open, intracranial surgery that is mainly used when a nearby blood vessel is putting pressure on the trigeminal nerve. To address this underlying cause of trigeminal nerve pain, a neurosurgeon will gently reposition the blood vessel that is compressing the trigeminal nerve. By reducing pressure on the nerve, the procedure can help relieve nerve pain. However, this surgery is one of the most invasive options, since the skull must be opened to access the trigeminal nerve.
Rhizotomy
In contrast to microvascular decompression, which addresses blood vessels near the trigeminal nerve, a rhizotomy affects the nerve itself. Techniques including heat, glycerin or a balloon can be used to destroy the fibers of the trigeminal nerve that signal pain to the brain.
Gamma Knife
Also known as brain stereotactic radiosurgery, a gamma knife procedure involves a neurosurgeon or radiologist delivering a highly focused dose of radiation to the root of the trigeminal nerve to reduce or stop pain signals. Gamma knife does not require anesthesia, as no incisions are made. Pain relief generally decreases over time and may not be noticeable right away.
Complementary Therapy
Complementary treatments – such as acupuncture, chiropractic and physical therapy – may help some individuals. Consult your OMS before adding complementary therapies to your treatment plan.
Collaboration with Medical Professionals
Diagnosing and treating trigeminal nerve pain often requires the cooperation of different healthcare professionals. Neurologists, neurosurgeons, OMSs, pain specialists and physical therapists can work together to create a comprehensive treatment plan tailored to your needs.
Everyone experiences trigeminal nerve pain differently. It is important to communicate openly with your OMS, follow your OMS’s recommendations and report any changes or concerns that may occur during treatment.
