Trigeminal neuralgia pain is undoubtedly a very painful and, in short, debilitating pain.

Trigeminal neuralgia pain begins like an electric shock. At first, the person doesn't understand what's happening. They think, "It must be a toothache," because they believe only a toothache could be this terrible. They go to the dentist, and they pull one, then two, then maybe three teeth. It doesn't help at all. Painkillers are almost completely ineffective. The pain typically feels like an electric shock, and when it strikes, it prevents them from speaking, eating, laughing, or doing anything else. Initially, it starts a few times a day, then the frequency can gradually increase. As the frequency increases, it becomes unbearable. Because it's sometimes triggered while eating, sometimes while talking, the patient begins to restrict themselves to avoid triggering the pain. They can't even explain to those around them how terrible the pain is. They can't eat or chew on the side of their face that's in pain.

Ultimately, a dentist, neurologist, or neurosurgeon will diagnose the condition. Trigeminal neuralgia is diagnosed solely based on the patient's symptoms. It cannot be diagnosed through MRI scans or other diagnostic tests.

We order brain MRIs, especially CISS sequence MRIs, for patients with trigeminal neuralgia. This is because it visualizes the trigeminal nerve, which originates in the brainstem and extends towards the face, and the surrounding blood vessels, revealing any tumors or vascular anomalies. In most cases of trigeminal neuralgia, there are no tumors, aneurysms, or problems like AVMs. However, epidermoid tumors can cause trigeminal neuralgia or glossopharyngeal neuralgia.

In trigeminal neuralgia, the pain is in the face. In glossopharyngeal neuralgia, the pain is in the throat, and the patient experiences very severe pain when swallowing.

Trigeminal neuralgia is caused by the trigeminal nerve, the fifth nerve in the brain, attaching to one of the cerebral vessels, usually the SCA and AICA, at the point where it exits the brainstem, and constantly receiving vibrations from this vessel. This vessel oscillates freely within the cerebrospinal fluid with each heartbeat. If, for an unknown reason, the vessel attaches to the nerve root, each oscillation causes a pulsation, resulting in severe pain.

We have a medication called Tegretol. If a patient starts using Tegretol and their pain decreases, then we can be sure it's trigeminal neuralgia. If they don't benefit from Tegretol, then it could be atypical trigeminal neuralgia, or we might be dealing with another facial condition that causes pain.

The only way to eliminate the cause of trigeminal neuralgia is to surgically relieve the nerve compression. Other treatments include trigeminal rhizotomy. Trigeminal rhizotomy can be performed by burning the nerve at 70 degrees Celsius with radiofrequency, chemically burning it, or compressing it with a balloon where the nerve enters the face.