What is Trigeminal Neuralgia?

Facts about trigeminal neuralgia

In Denmark, between 200 and 250 people are diagnosed with trigeminal neuralgia each year. There are between 5,000 and 10,000 people living with the condition in this country. Trigeminal neuralgia occurs slightly more often in women than in men and typically debuts around the age of 50. However, it can also occur in young people.

The pain jolts are described as extremely severe and can occur when the insulating fatty layer around a nerve root is worn away, causing a "short circuit between the nerves." The trigeminal nerve originates deep within the brain and branches out over the eye, across the cheek, toward the nose, and into the lower jaw.

Trigeminal neuralgia cannot be diagnosed with blood tests, but an MRI scan is often necessary. An MRI scan can, for example, show whether there is a so-called neurovascular contact, i.e., a blood vessel pressing on a nerve in the brain, or if there are other causes for the pain. If you have symptoms and a nerve compression is observed, it is called classic trigeminal neuralgia. An MRI scan will also be able to detect or rule out so-called symptomatic trigeminal neuralgia, meaning the trigeminal pain is a symptom of, for example, multiple sclerosis or a brain tumor. 

In many cases, there is no obvious cause or explanation for the trigeminal pain. This is called idiopathic trigeminal neuralgia.

Symptoms of trigeminal neuralgia

• Intense stabs or jolts lasting a few seconds, localized to one side of the face in one or more of the three facial nerve branches. 
• The pain jolts can come without warning, but many find that they are triggered by non-painful stimuli such as wind, cold, light touch like shaving, brushing teeth, eating, or simply talking.
• Approximately 50% experience a more constant, dull background pain between the pain jolts.

Treatment options for trigeminal neuralgia

• There are various types of epilepsy medication that can be effective against trigeminal pain. Sometimes it is necessary to combine several preparations to achieve the best possible effect. Which preparation and what dose you should take is individual. 
• Carbamazepine or Oxcarbazepine will be the first choice. If necessary, Gabapentin, Pregabalin, or Lamotrigine can be added.
• Botox treatment may be an option.
• Surgical procedures such as glycerol rhizotomy, balloon compression, or microvascular decompression may be considered for the approximately 30% for whom medical treatment is ineffective or not tolerated. This takes place via a referral to the Danish Headache Center. 
• There is usually no effect from painkillers such as paracetamol, ibuprofen, or morphine. 

Preventive treatment for trigeminal neuralgia

Preventive medical treatment is used during periods of pain to eliminate or reduce symptoms. The medication can often be tapered down or discontinued entirely for shorter or longer periods once you have been completely pain-free for at least 14 days. 

Can lifestyle changes help with trigeminal neuralgia?

There is no research evidence to suggest that lifestyle changes have an effect on trigeminal neuralgia.

A precise diagnosis and an appropriate treatment plan are important. 

Trigeminal neuralgia can have a significant negative impact on quality of life. It is essential to understand both the symptoms and the treatment options in order to manage the condition effectively. It is important to seek professional medical help to obtain an accurate diagnosis and a tailored treatment plan.