Trigeminal Neuralgia

Trigeminal neuralgia is a nerve disorder that causes sudden, brief episodes of severe stabbing or electric shock-like pain in parts of the face.

The pain comes from the trigeminal nerve, the major sensory nerve of the face. This nerve is responsible for sending impulses of touch, pain, pressure and temperature to the brain from the face, jaw, gums and tongue. Trigeminal neuralgia is usually caused by the compression of the trigeminal nerve by an artery or a vein, but it can also occur with no apparent cause. It is often misdiagnosed as a dental or jaw problem.

This condition can be extremely distressing for patients. Once correctly diagnosed, there are several medical and surgical treatment options that may reduce or relieve this debilitating pain.

Symptoms of trigeminal neuralgia include:

  • Very painful, sharp, electric shock-like facial pain that usually lasts a few seconds or minutes.
  • Pain usually occurs on one side of the face only, often around the eye, cheek and lower part of the face.
  • Pain may be triggered by touch or sounds, or by everyday activities such as brushing teeth, chewing, drinking, eating, shaving and light touch on the face.

To confirm the diagnosis of trigeminal neuralgia and exclude other treatable causes of face pain, we will perform a thorough neurologic evaluation, including a review of your pain history, medications, treatments and procedures you have tried in the past. We will discuss your current treatment and review any neuroimaging scans related to your face pain, so please bring these scans with you to your appointment. We will then tailor further evaluations and treatment recommendations based on our findings and your preferences.

Medication is always the first line of treatment for trigeminal neuralgia. Patients who continue to experience pain despite the best medical management will be evaluated for surgery.

Medical Treatments for Trigeminal Neuralgia

The medicines doctors typically prescribe to treat trigeminal neuralgia were originally developed to treat epilepsy. However, this class of medications, called anti-convulsants, has been found to be quite effective in treating nerve pain, including trigeminal neuralgia, when taken on an ongoing basis.

The anti-convulsant drug most commonly prescribed for trigeminal neuralgia is carbamazepine (Tegretol), which can provide at least partial pain relief for up to 80 to 90 percent of patients. Other anti-convulsants prescribed frequently for trigeminal neuralgia include:

  • Phenytoin (Dilantin)
  • Gabapentin (Neurontin)
  • Lamotrigine (Lamictal)
  • Oxcarbazepine (Trileptal)
  • Topiramate (Topamax)

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UCSF Clinics & Centers

Neurology and Neurosurgery

Trigeminal Neuralgia
400 Parnassus Ave., Eighth Floor
San Francisco, CA 94143
Phone: (415) 353-2892
Fax: (415) 353-2898
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