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Trigeminal Neuralgia

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Trigeminal neuralgia is a condition of the fifth cranial nerve, also known as the trigeminal nerve, which transmits signals between the brain and the face, eyes, and teeth as well as the muscles that control chewing.

Trigeminal neuralgia (also known as TN, or tic douloureux) is a chronic condition that causes intense facial pain, usually down one side of the face. It most commonly develops in those over 50, particularly women, but it can occur in younger people and men as well.

Trigeminal neuralgia is not life-threatening, but the pain — variously described as burning, stabbing, or like an electric shock — can be severe enough to cause physical and emotional distress.

Typically, when the condition first develops the pain comes and goes, with painful episodes lasting only a few seconds and with long intervals between attacks. As the condition progresses the pain becomes constant or the interval between episodes becomes shorter — sometimes only a few minutes. Sleep provides respite, but symptoms resume upon awakening.

The source of the pain is the trigeminal nerve, also known as the fifth cranial nerve, or CNV. The trigeminal nerve transmits signals between the brain and the face, eyes, and teeth as well as the muscles that control chewing. (If you’ve ever experienced a “brain freeze” or "ice cream headache" from slurping a milk shake or a frozen drink, you’ve met your trigeminal nerve.) There are two trigeminal nerves, one on each side of the face, and each has three branches: the ophthalmic nerve, the maxillary nerve, and the mandibular nerve. Trigeminal neuralgia can affect any of these three, but is most commonly a condition of the maxillary and mandibular nerves.

Episodes of trigeminal neuralgia may be spontaneous, or they may be triggered by mild stimulation of the face (such as shaving, applying makeup, chewing, washing, and even exposure to wind). Over time, the attacks can grow in duration, intensity, and frequency (see Symptoms of Trigeminal Neuralgia).

In most patients, most of the pain comes in sudden, sharp bursts — this is considered Type 1 trigeminal neuralgia. In others, the pain is more continuous and is described as aching or burning, with sharp bursts of pain occurring intermittently — this is considered Type 2 trigeminal neuralgia. The treatment is the same regardless of the type.  (See Diagnosing and Treating Trigeminal Neuralgia).

What Causes Trigeminal Neuralgia?
There are several possible causes of trigeminal neuralgia, including ordinary aging. In many cases, trigeminal neuralgia is caused by an abnormal blood vessel or tumor pressing on the trigeminal nerve; the pain can also be a result of multiple sclerosis. Other possible causes are aneurysm;  posterior fossa tumor,  arachnoid cyst, brain stem disease resulting from a stroke, or a traumatic injury. Sometimes there is no clear cause of the pain (known as idiopathic trigeminal neuralgia), so the condition can therefore be difficult to diagnose.

There are several different approaches to treating trigeminal neuralgia, depending on its cause (see Diagnosing and Treating Trigeminal Neuralgia).

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Reviewed by: Jared Knopman, M.D.
Last reviewed/last updated: October 2020
Illustration by Thom Graves, CMI

Doctors Who Treat Trigeminal Neuralgia

Many people consult their primary care physicians when they first experience the symptoms of trigeminal neuralgia. Primary care physicians may prescribe the medications that are the initial treatments, but more severe cases should be referred to a neurosurgeon for evaluation. Expert treatment for trigeminal neuralgia may include open surgery, minimally invasive surgery, stereotactic surgery, or advanced pain management — all of which are best conducted at experienced neurosurgery centers.

At the Weill Cornell Brain and Spine Center, the neurosurgical experts who treat trigeminal neuralgia include:

Dr Philip E. Stieg, Weill Cornell MedicinePhilip E. Stieg, Ph.D., M.D., Chairman of the Neurosurgery Department at Weill Cornell Medical Center and Neurosurgeon-in-Chief at NewYork-Presbyterian Hospital. Dr. Stieg specializes in cerebrovascular surgery, including the microvascular decompression surgery that relieves the pain of trigeminal neuralgia. (Read more about Dr. Stieg.)

Dr. Michael KaplittDr. Michael Kaplitt, Vice Chairman of the Neurosurgery Department at Weill Cornell Medical Center. Dr. Kaplitt specializes in functional neurosurgery and directs the department’s programs on movement disorders (including Parkinson's disease, essential tremor, and dystonia), pain and spasticity,  trigeminal neuralgia, and hydrocephalus. (Read more about Dr. Kaplitt.)

Dr. Jared KnopmanJared Knopman, M.D., specializes in the treatment of vascular diseases of the brain and spine and has dual expertise in both open neurosurgical and minimally invasive interventional techniques. Dr. Knopman has done specialized fellowship training in endovascular neurosurgery and interventional neuroradiology at Weill Cornell Medical College and has surgical and interventional expertise in treating a diverse array of diseases of the brain and spine. Given his dual training, he is able to offer each patient an individualized treatment plan. (Read more about Dr. Knopman.)

Dr. Susan PannulloDr. Susan Pannullo, director of Neuro-Oncology in the Department of Neurological Surgery at New York-Presbyterian Hospital/Weill Cornell Medical Center.  Dr. Pannullo is Board Certified in both Neurology and Neurological Surgery, and specializes in stereotactic radiosurgery. (Read more about Dr. Pannullo.)

These four neurosurgeons lead teams of highly trained specialists across a range of disciplines (including neurology and pain management) to achieve the very best results for individuals suffering from the pain of trigeminal neuralgia.

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