Trigeminal Neuralgia aka Face Pain

 

Trigeminal Neuralgia derives its name from the fact that the fifth cranial nerve has three parts.  The fifth nerve is the nerve that transmits sensation, pain, temperature, and touch from the skin and mucosa of the face to the brain.  We loosely divide trigeminal neuralgia into classic or typical trigeminal neuralgia (also know as Tic douloreux) and atypical trigeminal neuralgia which encompasses almost all other face pain syndromes of otherwise unknown origin.  Of course if the pain is found to come from a tooth abscess, sinus disease, tempormandibular joint (TMJ), neuroma, nerve tumors, multiple sclerosis or other reason treatment is directed to the root cause, pun intended.

If the pain has characteristics of typical or atypical trigeminal neuralgia with no known source for the pain and medical therapy has failed, the patient may benefit from exploration and microvascular decompression (MVD) of the fifth cranial nerve.  Other treatments involve destructive procedures such as Gamma Knife, Cyber Knife, balloon compression, or radiofrequency rhizotomy.  All of the procedures, except MVD involve partially destroying the nerve and uniformly cause some numbness. 

The internet is full of sites with information, some of it accurate.  The Trigeminal Neuralgia Association (TNA) (insert link) was started in Pittsburgh while I was a resident there and has become a great source for information about the disease and treatment options.  The Mayfield Clinic, The Mayo Clinic, and others are also  good sites to learn about the disease and treatment options.  A talk I made to a local chapter of the TNA was recorded and is on YOU TUBE (insert link)

Most importantly find a good neurologist to make an accurate diagnosis and initiate the appropriate medical therapy.  At times no surgery or destructive procedure is needed.  If it is needed, find a neurosurgeon with whom you are comfortable and who is well trained and performs the operation routinely.

Several of my patients have volunteered to share their story with patients with trigeminal neuralgia.  Contact my assistant, Erika, or my nurse Joanie at 713-441-3800 for further information.