Trigeminal neuralgia is a chronic neuropathic disorder that affects the trigeminal nerve, which conducts sensations from the face to the brain. This neuralgia is characterized by a severe and intense pain in the areas of the face and the scalp, where the nerve provides sensitivity.
The wearing away or damage to the protective coating around the nerve, knows as myelin sheath, causes a type of electric discharge, perceived as a shock-like facial pain. It generally occurs when a blood vessel presses on the trigeminal nerve as it exits the brain stem. Neuralgia is known as the most excruciating pain in the world.
Pain episodes can occur without warning or be triggered by touching certain areas of the face, called trigger zones. These zones are usually near the lips and tongue. Therefore, activities like eating, talking, drinking or smiling can trigger an attack. The pain is felt for a few seconds and can last up to some minutes. Pain is described by patients as a “pins and needles” sensation, an electric shock or extreme sensitivity, such as jabbing and burning.
As the pain episodes are brief and recurrent, common painkillers are not usually helpful, but other medicine, specially certain anticonvulsants (which may stabilize nerve membranes), may cause relief, such as carbamazepine, oxcarbazepine, gabapentin or phenytoin.
If intense pain continues, surgery can be performed. If the cause is an artery situated in an anomalous position, the surgeon separates this artery from the nerve. This procedure (called vascular decompression) usually relieves the pain for many years. If the cause is a tumor, it can be surgically removed.
If medication does not relieve the pain and surgery is not indicated, a variety of nerve-block treatments are available, including nerve fiber destruction by injection of medication, such as glycerol; radiofrequency thermal lesioning (using heat) or Gamma-Knife stereotactic radiosurgery (using radiation); and balloon compression.
