Facial pain syndromes, including trigeminal neuralgia

Facial pain is a common occurrence that many individuals encounter at some stage in their lives. Whether it’s a throbbing headache, bothersome toothache or discomfort related to sinuses, facial pain can be a real nuisance. However, within the realm of facial pain syndromes, there is a particular type of pain known as trigeminal neuralgia that deserves special attention.

Trigeminal neuralgia

Trigeminal neuralgia is a neuropathic disorder that affects the trigeminal nerve, which is responsible for transmitting sensations from the face to the brain. It manifests as a distinct type of pain, often described as an electrical shock or the sensation of a live battery wire being dragged across the face. The pain is typically unilateral, focusing on the eye, nose and mouth areas, which correspond to the three branches of the trigeminal nerve. The pain can be triggered spontaneously or by external factors such as:

  • Changes in air temperature
  • Activities such as chewing or eating
  • Gentle touching of the face
  • Speaking or engaging in conversations

Sufferers often liken the sudden jolts of pain to lightning bolts. While patterns may emerge, the episodes can occur without rhyme or reason.


Trigeminal neuralgia involves a blood vessel coming into contact with the affected nerve. Think of the brain as a computer, the nerve as a cord and the three branches of the trigeminal nerve as a plug.  The most vulnerable point lies where the wire comes out of the computer, known as the dorsal root entry zone. When an artery rests on this entry zone, it exerts pressure, creating a cross-circuit that disrupts the normal functioning of the nerve. Inside the nerve, there are three types of fibers:

  • A and B fibers for normal touch and sensation
  • C fibers responsible for pain

This cross-circuit triggers an electrical jolt, leading to intense pain experienced by the patient.


With trigeminal neuralgia, early diagnosis is crucial. This starts with a physical examination conducted by your physician. During this evaluation, your physician will inquire about various aspects of your pain, including its frequency, duration, type and precise location. In some cases, if further investigation is warranted, your physician may recommend imaging techniques, such as a high-resolution MRI. By utilizing this advanced imaging technology, your healthcare team can accurately pinpoint the precise location of any arteries or blood vessels that may be exerting pressure on the affected nerve, aiding in the diagnostic process.

Seeking the expertise of an experienced surgeon as soon as symptoms arise is essential to guide the management process effectively. Delaying treatment increases the risk of irreversible pressure, significantly reducing the success rates. When the responsible blood vessel is carefully moved away from the nerve, patients often experience relief from their pain.

Treatment options

  • Medication: While certain medical therapies and drugs may alleviate trigeminal neuralgia, it is important to note that narcotics typically offer little relief. Trigeminal neuralgia can present as both typical and atypical over time, making its management a complex endeavor.
  • Ablation therapy: Another method involves selectively destroying the C fibers through ablation therapy. However, this technique can be challenging, as the destruction may inadvertently extend beyond the targeted fibers, resulting in numbness and decreased effectiveness over time due to nerve regeneration.
  • Stereotactic radiosurgery (Cyberknife): Another effective option typically utilized for older patients who may not be suitable candidates for other treatments. This approach employs highly precise beams of high-dose radiation to target the trigeminal nerve roots, providing relief from facial pain.
  • Microvascular decompression (MVD): A surgical option where a surgeon locates the artery causing the compression and creates a cushion to protect the nerve. This delicate procedure, lasting approximately two hours, involves using a material resembling a Q-tip, typically made of Teflon, to shield the nerve from the pulsating artery.

At NorthShore – Edward-Elmhurst Health, we take a collaborative team approach to address a wide range of facial pain syndromes. Our dedicated team utilizes minimally invasive techniques and stays at the forefront of the latest medical technology. To learn more about facial pain syndromes and trigeminal neuralgia, visit us online or call 847-618-4430.