Trigeminal neuralgia can cause debilitating facial pain. Consultant neurosurgeon Mr Harith Akram explains the causes of trigeminal neuralgia and the treatment options available to you if you are suffering from this condition.

If you are suffering from attacks of severe, sharp, electric shock-like facial pain, you may have something called trigeminal neuralgia. Trigeminal neuralgia symptoms can last from seconds to minutes at a time and can sometimes come in clusters occurring closely together. They can be triggered by everyday events such as talking, eating or brushing your teeth. Even touching your face can trigger an attack in some cases.  Trigeminal neuralgia is often mistaken for dental pain when the attacks first begin.

Anyone can suffer from trigeminal neuralgia without having any other neurological conditions. However, there is a higher prevalence in patients with conditions such as multiple sclerosis. It is very rare for children to have trigeminal neuralgia.

What causes trigeminal neuralgia?

Although there is still a lot to learn about the condition, it is believed that classical trigeminal neuralgia is triggered by a blood vessel compressing the trigeminal nerve as it enters the brainstem. Some patients are thought to be more naturally susceptible to developing the condition.  

Sometimes, trigeminal neuralgia symptoms can occur without obvious nerve compression, which is called idiopathic trigeminal neuralgia.

In rarer occurrences, the trigeminal nerve can be compressed by something else, like a brain tumour, an aneurysm or an arteriovenous malformation. Alternatively, you might have an existing condition which damages myelin (a coating that insulates the nerve), such as in multiple sclerosis. This is called secondary trigeminal neuralgia.

How can I alleviate the symptoms of trigeminal neuralgia?

If possible, avoid doing the things that you know triggers your facial pain, although that might not always be straightforward. It might also be helpful to use a mouth wash that contains a local anaesthetic (usually used to treat a sore throat) which will help to numb your mouth and can provide some relief.

When should I ask for specialist help?

If your symptoms persist, you should contact your GP. Mild trigeminal neuralgia pain can often be treated with medications. If your condition does not improve, or you suffer from severe side effects from the medications, then it may be worth looking for more specialist support.

If you are referred to a neurologist, then you will need to have an MRI scan to rule out any secondary causes for your facial pain. Once that has been determined there are a few treatment options available. At the National Hospital for Neurology and Neurosurgery, your best course of action will be considered by a multidisciplinary team of neurologists and neurosurgeons who specialise in trigeminal neuralgia treatment.

What treatment options are available?

There is a range of potential treatment options available to help to alleviate your facial pain.

If the cause of your neuralgia is due to a blood vessel compressing the trigeminal nerve, then microvascular decompression (MVD) can be performed. This is where the surgeon will place a special pad between the trigeminal nerve and the blood vessel affecting it which stops them from making contact. The surgeon, using a microscope, will identify the trigeminal nerve and any compressing vessels. The surgeon will then separate the vessels from the nerve and move them away so that the nerve is no longer compressed.

You will stay in hospital for three to four days and can return to full activity in about four to six weeks.  Around 70 to 80 per cent of patients who have this treatment become pain free and off medication in the long term.  As with all surgery, there are some risks, which your surgeon will discuss with you before you proceed.

If your neuralgia is not caused by a compressed nerve, then internal neurolysis or "combing" of the nerve may be a more suitable treatment option.  This is a process which separates out nerve fibres. This is effective in 50 to 60 per cent of patients. There is almost always some degree of facial numbness after this procedure, but the degree can vary in severity. Other risks include the potential for a residual burning pain, which can be difficult to manage, but the risk of this is low. Any other risks will again be discussed before you proceed with any treatment. For this procedure you would usually stay in hospital for three to four days, and again return to your regular activities within four to six weeks.

Gamma knife is a non-invasive treatment option for trigeminal neuralgia. The results are good and 40 per cent of patients achieve good pain control (on medication) five years after surgery. The pain relief is not felt immediately after Gamma knife treatment and can take up to six months to occur.

Other surgical options include needle ablation with either radiofrequency, balloon compression or glycerol injection. These are less invasive procedures and are performed as a day case. Patients usually respond very well to these procedures in the short term, but pain tends to recur after two to three years. These procedures are all low risk but can sometimes lead to facial numbness and some other health issues, which your consultant can discuss with you.

Why should I have my trigeminal neuralgia treatment with UCLH Private Healthcare?

The National Hospital for Neurology and Neurosurgery at Queen Square is a highly specialised academic neurology and neurosurgery hospital. Our specialist team has a vast experience in managing complex trigeminal neuralgia cases, including for patients who have been unsuccessfully treated elsewhere for the condition. We can provide state-of-the-art diagnostic facilities as well as offering all trigeminal neuralgia treatment options. The team is also highly experienced in supporting patients with other headache and facial pain conditions, if tests results suggest an alternative treatment plan is required.