Trigeminal neuralgia is a condition caused by dysfunction of the trigeminal nerve, which is responsible for the sensory innervation of most of the face’s surface as well as the motor function of the masticatory muscles. Therefore, it plays an important role in chewing.
Dysfunction of this nerve manifests with extremely intense but short-lasting pain, usually located in the lower jaw and cheek, but it can also appear in the upper jaw, temple, forehead, or around the eye.
The pain from trigeminal neuralgia may recur multiple times per day and can be triggered by actions such as speaking or chewing. It may be so severe that simple activities like chewing, swallowing, brushing the teeth, washing the face, or even light touch of the skin can become extremely painful.
It occurs most commonly after the age of 50 and is more frequent in women.
The exact etiology is not fully clarified, but it is largely attributed to compression of the nerve, often at the point where it emerges from the brainstem, by a blood vessel or, less commonly, by a tumor. This compression leads to loss of the myelin sheath (demyelination), resulting in the general dysfunction of the nerve.
Trigeminal neuralgia can also appear secondarily in the context of demyelinating diseases such as multiple sclerosis.
However, in many cases, no clear anatomical cause is identified—this is referred to as idiopathic trigeminal neuralgia.
In all cases, once the diagnosis of trigeminal neuralgia is made, the patient undergoes magnetic resonance imaging (MRI) to rule out serious underlying conditions such as tumors or multiple sclerosis, and to identify any possible anatomical reason for nerve compression at its root entry zone.
Treatment can be conservative or surgical.
Conservative treatment involves the use of neuromodulationg medications such as carbamazepine, gabapentin and pregabalin.
If conservative therapy fails or medications are not tolerated, surgical options are recommended.
The techniques may be less or more invasive and aim either to relieve nerve compression (microvascular decompression) or to destroy the trigeminal ganglion by gamma knife radiosurgery, percutaneous balloon microcompression or Percutaneous radiofrequency neurolysis of the ganglion, or to destroy the nerve itself with Percutaneous glycerol rhizolysis by destroying the nerve root.
Yes, in mild cases, complementary therapies such as physiotherapy, acupuncture, and relaxation techniques can help. However, these methods do not replace medical treatment but serve as supportive approaches.
Anxiety does not cause the condition, but it can trigger or worsen episodes of pain. Stress management through psychological support, mindfulness, or by relaxing can reduce the frequency and intensity of flare-ups.
Yes, many times patients believe they have a dental problem because the pain is located in the jaw or teeth. This is why a dental evaluation often takes place before the diagnosis of trigeminal neuralgia is made.
Herbs with anti-inflammatory or relaxing properties, such as chamomile or St. John’s wort (Hypericum perforatum), may offer mild relief. However, their use should always be done in consultation with a doctor, because they do not replace medical treatment.
Yes, acupuncture can reduce the intensity and frequency of pain episodes, especially when used as a complementary therapy alongside standard medical treatment.
It is a minimally invasive technique in which a special catheter delivers radiofrequency energy to the trigeminal ganglion, with the goal of deactivating the nerve fibers that cause the pain. It is a safe and effective method when medications are not sufficient.
Microvascular decompression is a surgical technique that removes the blood vessel pressing on the trigeminal nerve.
Balloon compression is a minimally invasive technique in which a special catheter and balloon apply pressure to the nerve’s ganglion in order to reduce the transmission of pain signals.
