Trigeminal Neuralgia

What is Trigeminal Neuralgia?

Trigeminal neuralgia involves the fifth cranial nerve, which carries sensation from the face to the brain. When this nerve is irritated, often by a blood vessel pressing against it at the brainstem, the result is sudden and extreme facial pain. The attacks are typically brief, lasting seconds to two minutes, but they can cluster in rapid succession and leave the face hypersensitive between episodes.

The pain is described as an electric shock, a sharp stabbing, or a burning lancination, usually affecting one cheek, jaw, teeth, or the area around the eye. Triggers are mundane: chewing, talking, cold air, a light touch on the face, or brushing the teeth. Because these triggers are unavoidable, the condition severely disrupts eating, speaking, and daily function. Classical trigeminal neuralgia (the most common form) is caused by vascular compression. Secondary causes include multiple sclerosis, tumours, or nerve injury.

Over time, attacks tend to increase in frequency and duration without treatment. Early intervention prevents the condition from becoming constant background pain with superimposed attacks.

Symptoms

• Sudden, severe, electric-shock or stabbing pain on one side of the face
• Episodes lasting seconds to two minutes, often occurring in rapid bursts
• Triggers including eating, speaking, touching the face, or cold wind
• Pain in the cheek, jaw, teeth, gums, or around the eye on the affected side
• A dull ache or burning sensation in the face between sharp attacks
• Avoidance of eating or talking due to fear of triggering an episode

How We Treat It

Carbamazepine remains the standard first-line medication and works well for many patients, but tolerability declines over time and some patients reach doses that cause unacceptable side effects. When medication is inadequate, we offer interventional options targeting the Gasserian ganglion, the junction point of the trigeminal nerve at the skull base.

Radiofrequency ablation of the Gasserian ganglion is our primary procedure: it selectively reduces the nerve’s ability to transmit pain signals and provides relief lasting five to ten years in well-selected patients. The procedure is performed under image guidance with sedation and takes under an hour. Botox injections along the trigeminal territory are an option for patients who want a less invasive approach, though the effect lasts three to six months and requires repetition. We work with neurosurgery colleagues for patients who are candidates for microvascular decompression, which addresses the root cause directly.