Five things you should know about trigeminal neuralgia

Imagine having a root canal without local anesthesia.

What if that pain came back on a regular basis? What if each episode was a little worse than the last? And what if it was triggered by ordinary activities—shaving, brushing your teeth, eating, or even smiling?

Welcome to the real-life difficulties experienced by people diagnosed with trigeminal neuralgia, a rare and excruciating disorder caused by an abnormality in the trigeminal nerve, which transmits signals from the brain to the face.

“People describe it as the worst pain imaginable,” said M Health Fairview Neurosurgeon Andrew Grande, MD, FAANS, FAHA, who specializes in the diagnosis and treatment of trigeminal neuralgia.

To help reduce that pain, Grande and M Health Fairview Neurosurgeon David Darrow, MD, have established a multidisciplinary treatment program. In the vast majority of cases, they’re able to help people diagnosed with the condition go on to live normal, mostly pain-free lives. We asked Grande to tell us five things you should know about trigeminal neuralgia.

Trigeminal neuralgia is extremely rare.

Only about 12 out of every 100,000 people are diagnosed with trigeminal neuralgia (TN) in any given year, so you’re not likely to get it. But the condition’s rarity can also be part of the problem, Grande said. Most people with TN have never met another person with it. They are often misdiagnosed or have difficulty finding an experienced specialist. Trigeminal neuralgia can strike anyone, but it’s most common in people older than 50. And the disease is more common in women than men.

Researchers are still digging into the cause of some cases of trigeminal neuralgia.

In many cases, TN is caused when a nearby artery becomes compressed against the trigeminal nerve. Over time, the proximity of the artery can wear away the nerve’s protective barrier, causing the pain. In these instances, Grande said, surgeons are able to correct the problem by moving the artery away from the nerve. That isn’t universally true, however, and researchers believe an underlying problem in the nerve or the sheath protecting the nerve may also trigger the condition.

There are a variety of treatments to alleviate trigeminal neuralgia.

Typically, the first line of defense against TN is medication. Anti-epileptic drugs, intended to prevent seizures, often work well. However, such medication can also produce side effects—drowsiness, dizziness, mental slowness—that some people find intolerable. There are a variety of surgical options for those who find medication ineffective or problematic. Options include procedures to relieve pressure on the nerve or to intentionally damage it, which interferes with the nerve’s ability to transmit painful sensations.

We offer a wide range of leading-edge treatment options.

“One of the unique things about our program is the toolkit of treatment options we offer,” said Grande.

This toolkit includes microvascular decompression, along with a range of ablative procedures – meaning procedures to ease pain by injuring the nerve.

Microvascular decompression identifies the trigeminal nerve and the vessel compressing it, then moves that vessel away from the nerve and puts a barrier between them. This is typically the most successful treatment option when it comes to permanently relieving pain – however it’s not always the best option for patients. We look at each person’s unique situation – including the cause of their trigeminal neuralgia.

“In some cases, patients don’t have a vessel compressing the nerve. Other patients may not be good candidates for surgery,” said Grande. “In those cases, we have a range of ablative procedures that we can offer patients.”

One of these ablative options is radiosurgery. M Health Fairview University of Minnesota Medical Center is the first hospital in Minnesota to use the newest generation of Gamma Knife radiosurgery – the Gamma Knife Icon. Radiosurgery uses targeted radiation to destroy tissue with no incision or general anesthesia necessary.

Darrow is also looking into newer therapy options using neuromodulation – targeted electrical stimulation – to treat patients with more complex cases. These new procedures are a breakthrough for the treatment of traditionally very challenging facial pain.

M Health Fairview is uniquely positioned to treat trigeminal neuralgia.

M Health Fairview’s multidisciplinary approach to medicine is especially beneficial for people with TN, who may also need help managing TN-related complications. In addition to Grande and Darrow, M Health Fairview’s TN team includes an ear, nose, and throat surgeon; a neuro-radiologist; a dentist devoted to the treatment of facial pain; a psychologist specializing in pain management; and a pharmacist, among others.

“Our goal is not only to help people become pain free, but to keep them pain free,” Grande said. “If we try one solution and there is a recurrence of pain, we have a Plan B, a Plan C, and a Plan D.”