Trigeminal Neuralgia & Craniofacial Pain Syndrome
The most common craniofacial pain syndrome is trigeminal neuralgia. Trigeminal neuralgia is a facial pain syndrome that usually develops in individuals over 50 years old. Its incidence is 4/100,000, and it is the most common facial pain syndrome in this age group. Trigeminal neuralgia affects the trigeminal nerve, which carries sensation from face to brain. Even mild stimulation of the face — such as brushing teeth, shaving, eating or putting on makeup — may trigger a jolt of excruciating pain. Initially the pain may be mild, however it can progress and cause longer more frequent bouts of searing pain.
Causes
Causes are uncertain. Trigeminal neuralgia can occur as a result of aging, or it can be related to multiple sclerosis or a similar disorder that damages the myelin sheath protecting certain nerves. Less commonly, trigeminal neuralgia can be caused by a tumor compressing the trigeminal nerve.
Diagnosis
Imaging studies, CT or MRI, with and without contrast enhancement, are normally performed on every patient with trigeminal neuralgia. Often, elongated and tortuous vessels can be seen and tumors of the region need to be excluded as a cause for the syndrome.
Treatment
The primary treatment of trigeminal neuralgia is pharmacological. Physicians treat it with medications and injections. However, after pharmacologic failure, surgical intervention is necessary. Surgical options include blocking the trigger point with local blocks, neurectomy — block of the nerve branches, percutaneous rhizotomy of the trigeminal ganglion (destruction of the site of sensory nerve cell bodies just inside the skull and dura), Gamma Knife stereotactic radiosurgery, and microvascular decompression of the nerve root zone.
Decisions on which treatment is best for a given patient must be based on the nature of the pain, the health of the patient, imaging findings and consultation with the neurosurgeon.
The most common craniofacial pain syndrome is trigeminal neuralgia. Trigeminal neuralgia is a facial pain syndrome that usually develops in individuals over 50 years old. Its incidence is 4/100,000, and it is the most common facial pain syndrome in this age group. Trigeminal neuralgia affects the trigeminal nerve, which carries sensation from face to brain. Even mild stimulation of the face — such as brushing teeth, shaving, eating or putting on makeup — may trigger a jolt of excruciating pain. Initially the pain may be mild, however it can progress and cause longer more frequent bouts of searing pain.
Causes
Causes are uncertain. Trigeminal neuralgia can occur as a result of aging, or it can be related to multiple sclerosis or a similar disorder that damages the myelin sheath protecting certain nerves. Less commonly, trigeminal neuralgia can be caused by a tumor compressing the trigeminal nerve.
Diagnosis
Imaging studies, CT or MRI, with and without contrast enhancement, are normally performed on every patient with trigeminal neuralgia. Often, elongated and tortuous vessels can be seen and tumors of the region need to be excluded as a cause for the syndrome.
Treatment
The primary treatment of trigeminal neuralgia is pharmacological. Physicians treat it with medications and injections. However, after pharmacologic failure, surgical intervention is necessary. Surgical options include blocking the trigger point with local blocks, neurectomy — block of the nerve branches, percutaneous rhizotomy of the trigeminal ganglion (destruction of the site of sensory nerve cell bodies just inside the skull and dura), Gamma Knife stereotactic radiosurgery, and microvascular decompression of the nerve root zone.
Decisions on which treatment is best for a given patient must be based on the nature of the pain, the health of the patient, imaging findings and consultation with the neurosurgeon.