Trigeminal Neuralgia

When you have trigeminal neuralgia, there’s an abnormal transmission of electrical signals in your trigeminal nerve — often causing sudden pain. Sometimes, simply touching your face or having a strong breeze blow on it can trigger this reaction.

Because trigeminal neuralgia doesn’t often respond to over-the-counter (OTC) pain medications, like Tylenol^® or Advil^®, it’s important to find healthcare providers who understand your diagnosis and needs. At Cleveland Clinic, we treat many people each year with complex headaches and facial pain. So we know what it takes to accurately diagnose trigeminal neuralgia.

If you have severe facial pain, completing our online risk assessment is a great first step to getting relief. You’ll answer a few simple questions — and if your answers match up with signs of trigeminal neuralgia, a member of our team will contact you to discuss next steps.

Your first visit will be with our facial pain providers, including a neurologist. They’ll talk with you about your symptoms, do a physical exam and review any imaging you’ve already had. This information helps them make a diagnosis and decide if you need more tests.

They’ll also likely order an MRI to get 3D, high-resolution pictures of the blood vessels near your trigeminal nerve. This test helps them see where and how bad your trigeminal nerve compression is. And it can help them figure out if you’ll need surgery.

Meet Our Trigeminal Neuralgia Care Team

At Cleveland Clinic, your care team will include healthcare providers from several different specialties. They’ll work together and with you to provide the most personalized treatment plan for your needs. Your team could include:

• Neurologist.
• Neurosurgeon.
• Neuroradiologist (brain imaging specialist).
• Chronic pain rehabilitation specialist.
• Pain psychologist.

Trigeminal neuralgia won’t ever completely go away, which means your provider will need to keep a close eye on you even when you don’t have symptoms. You can expect to meet with our experts a few times a year. This makes it easier for them to quickly take care of your changing needs.

We use your test results to design a personalized treatment plan — one that helps you manage your symptoms each day. Sometimes it takes a few therapies to find relief. Our goal is to help you live as pain-free as possible for years after treatment.

Medications

You’ll usually start by taking trigeminal neuralgia medications, like anti-seizure (anticonvulsant) drugs. These medications disrupt signals from any overactive nerves that lead to pain and can help even if you don’t have a seizure disorder.

If you can’t take trigeminal neuralgia medications or tolerate the side effects, a nerve block injection (shot) may help. This therapy uses purified botulinum toxin or pain medications to block brain signals that cause trigeminal neuralgia pain.

Other medications your provider might prescribe could include tricyclic antidepressants or muscle relaxants. They might also recommend other things you can do along with drug therapy to help you relax — like yoga, meditation, low-impact exercise, chiropractic treatments and acupuncture.

Trigeminal neuralgia surgery

If medications aren’t working to control the pain or if they’re causing bothersome side effects, we may recommend surgery. If we decide surgery is the best option, you can rest assured you’re in good hands. Our neurosurgeons treat people with trigeminal neuralgia all the time with excellent results.

There are several different kinds of trigeminal neuralgia surgeries, including:

• Balloon compression rhizotomy: Your provider will insert a tube called a cannula through your cheek to reach your trigeminal nerve. They’ll send a catheter with a small balloon through the tube and inflate the balloon to compress the nerve, damaging pain-causing fibers.
• Glycerol injection rhizotomy: Your provider will use a needle to inject a liquid alcohol called glycerol into the root of your trigeminal nerve to create selective nerve damage. This can disrupt your body’s ability to send pain signals to your brain from that area.
• Radiofrequency thermal rhizotomy: We’ll insert a needle through your cheek to the base of your skull so we can send a safe electrical current to pinpoint the specific place where pain starts in your trigeminal nerve. Then, we’ll apply heat there to create a lesion (tissue damage) and destroy some of the nerve fibers to stop or slow pain signals.
• Microvascular decompression: This is the most common — and more invasive — surgery option. We’ll relieve pressure on your trigeminal nerve by implanting a tiny patch of sponge-like material to cushion the area between your trigeminal nerve and the blood vessel causing the problems.
• Gamma Knife surgery: This surgery uses a highly concentrated amount of radiation to create a lesion where your trigeminal nerve root meets your brain stem. This will disrupt how this nerve transmits pain signals to your brain.

Sometimes these surgeries can cause complications, like facial numbness and tingling or even hearing issues. Your provider will talk with you about all of this before you decide if you’ll have surgery.

It’s common for trigeminal neuralgia pain to come back even after successful treatment. Some of these surgeries provide pain relief for a year or two, while the effects of others, like microvascular decompression, can last for 10 years or longer.

Taking the Next Step

Trigeminal neuralgia can create a constant cycle. Electrifying jolts of pain in your face and head can stress you out. Stress makes you tense. And tension can cause more pain. And none of this is easy to live with. That’s why at Cleveland Clinic, we’re here to help you find relief with a careful diagnosis, personalized treatment and ongoing care and support.