Trigeminal neuralgia is a chronic (long-lasting) pain condition that affects the nerve that carries sensation from your face to the brain — called the trigeminal nerve. To a person with trigeminal neuralgia, even doing simple, daily tasks — such as washing your face or brushing your teeth — can cause debilitating pain in the face.

Trigeminal neuralgia usually affects people age 50 or older, and the condition occurs more often in women than in men. In most cases, pain and symptoms related to trigeminal neuralgia start out mild and infrequent. Over time, most people with the condition experience more severe pain, more frequently. At the University of Miami Health System, our expert neurosurgeons are experienced in delivering innovative treatment options for pain related to trigeminal neuralgia.

Diagnosis

If you are showing symptoms of trigeminal neuralgia, your doctor may conduct a thorough neurological examination and order certain diagnostic tests. Your neurosurgeon may order magnetic resonance imaging (MRI). MRIs use magnets and radio waves to create an image of the inside of your body, including your nerves, to look for damage.

Your neurosurgeon may also order an electromyogram. Electromyograms use electrodes to measure the electrical activity in your muscles. They can reveal if the problem is in your muscles and not your nerve.

Treatments

The neurosurgery team at the University of Miami Health System is experienced in providing innovative, effective treatment for trigeminal neuralgia. Your neurologist may recommend one or more medications to reduce or block the pain signals that your trigeminal nerve sends to your brain. If you have been taking medication for trigeminal neuralgia that is no longer effective, your specialist may recommend you try Botox injections to reduce or block pain.

If other, more conservative treatments are not effective in treating your trigeminal neuralgia, your neurosurgeon may recommend you undergo microvascular decompression. This surgical procedure moves or removes blood vessels that are in contact with the trigeminal nerve root to stop it from malfunctioning. In this procedure, your neurosurgeon makes a small incision behind your ear on the side in which you’re experiencing pain. Then, they create a small hole in your skull and move or remove the arteries that are in contact with the trigeminal nerve. This procedure is successful in reducing or eliminating pain for many people with the condition, but there are some risks, including hearing loss, facial weakness or numbness, or stroke.

Another surgical procedure that your neurosurgeon may recommend you try is a percutaneous stereotactic radiofrequency lesion procedure (RLF). In this procedure, your neurosurgeon uses radiofrequency to destroy the trigeminal nerve. During this procedure, your neurosurgeon uses X-ray guidance to insert a needle in your cheek on the side of your face in which you’re experiencing pain. The needle is guided to your trigeminal nerve. Once there, your neurosurgeon passes an electrical current through the needle and into the nerve. This process will be repeated until you are no longer feeling pain on that side of your face.

Prognosis
After undergoing a RFL procedure, you may experience some unpleasant side effects, including numbness or a stinging or burning sensation. Another side effect that sometimes occurs with procedures aimed to treat trigeminal neuralgia is weakness of the muscles that enable you to chew your food. This typically goes away with six to eight months. A third side effect that can occur after undergoing trigeminal neuralgia treatment is numbness of the eye of the affected side.