Facial Pain & Trigeminal Neuralgia
Western Massachusetts’ Leader in Treating Facial Pain
If you have severe facial pain, caused by trigeminal neuralgia, also called tic douloureux, you don’t have to deal with it alone. We understand the pain and challenges you’re dealing with.
Our specialized neurologists and expert neurosurgeons can help. We’re the only healthcare system in western Massachusetts that treats trigeminal neuralgia; we treat more people for it than some of the state’s largest medical institutions.
People from across the country and around the world come to us for help with their facial pain. We’ll work with you to create a customized treatment plan based on your symptoms, concerns, and needs.
What Is Trigeminal Neuralgia?
Trigeminal neuralgia is a chronic (long-lasting) condition that affects the trigeminal nerves in your face. You have two trigeminal nerves — one on each side of your face. And each trigeminal nerve has three branches: ophthalmic, maxillary and mandibular. These nerves transmit pain and other sensations from your face to your brain.
The location of your pain depends on the part of the trigeminal nerve that’s affected. Most people only have one affected nerve and usually feel pain in the lower part of their face.
Here you can learn more about trigeminal neuralgia, how to know if you have it, and understand some of the treatment options.
What’s causing your facial pain?
Meet Dr. Kamal Kalia
Dr. Kalia is an expert in the treatment of trigeminal neuralgia. He trained under Dr. Peter Jannetta at the University of Pittsburgh; Dr. Jannetta pioneered life-changing neurosurgery procedures including the treatment of trigeminal neuralgia.
Take the Trigeminal Neuralgia Assessment
Is there a cure for trigeminal neuralgia?
In certain circumstances, trigeminal neuralgia can be cured. If your trigeminal neuralgia is the result of a blood vessel making contact with the trigeminal nerve in your face, you may be a good candidate for microvascular decompression (MVD) surgery. MVD provides permanent relief for about 80% of patients.
Trigeminal Neuralgia Causes, Symptoms & Diagnosis
The main symptom is severe, recurring facial pain, stabbing or electrical shock in your cheek or jaw. It’s been described by some people as “the worst pain known to humanity,” and as a "lightning bolt through the face."
People with trigeminal neuralgia usually remember exactly when they first experienced the pain from this condition. The pain may last just a few seconds or as long as a few minutes. Most people go weeks, months, or even longer without pain, but those pain-free periods are followed by episodes of severe pain over a long period.
The pain from trigeminal neuralgia is often triggered by certain activities, like:
- Being touched on the face
- Brushing your teeth
- Eating
- Feeling the wind on your face
- Talking
- Washing your face
Some patients may avoid eating, talking, and other trigger behaviors to try to avoid the pain. Unfortunately, trigeminal neuralgia can progress and cause pain that gets worse with episodes that last longer.
Trigeminal neuralgia occurs when a blood vessel presses against the trigeminal nerve (called vascular compression). You have two trigeminal nerves in your face — one on each side – that transmit pain and other sensations from your face to your brain.
Women are more likely than men to develop trigeminal neuralgia.
It can be caused by things like dental procedures and facial trauma, as well as having:
- Multiple sclerosis (MS), because MS can damage the nerve’s myelin sheath (its protective coating)
- A brain tumor, because the tumor can press on the trigeminal nerve.
At what age do people get trigeminal neuralgia?
Most people with trigeminal neuralgia are over 50. However, you can develop the condition at any age. You’re more likely to have trigeminal neuralgia at a younger age if you’ve been diagnosed with MS.
Are there foods that trigger trigeminal neuralgia?
Your doctor will recommend that you pay attention to triggers that affect your trigeminal neuralgia. Some peoples’ trigeminal neuralgia is triggered by foods, but you don’t need to avoid specific foods if they don't trigger attacks. However, it's always important to maintain a healthy, nutrient-rich diet.
Your doctor will ask you a series of questions. This includes asking you to describe your pain. Based on the type of pain you experience, where the pain is located, and the things you may be doing when the pain starts, they’ll decide if they think you have trigeminal neuralgia.
Once you’re diagnosed with trigeminal neuralgia by one of our neurologists, you’ll work together to determine the best treatment for your situation.
First, they'll prescribe a medication called carbamazepine (known as Tegretol or Carbatrol), which is commonly used to treat seizures. If this medication relieves your pain, you likely have trigeminal neuralgia.
If your doctor diagnoses you with trigeminal neuralgia, you’ll have an MRI (magnetic resonance imaging exam). This is to make sure your trigeminal neuralgia isn’t the result of MS (multiple sclerosis) or a brain tumor, both of which can affect your treatment.
Treating Trigeminal Neuralgia – Medical & Surgical Options
- Medication
- Surgery — Microvascular Decompression
- Surgery — Glycerol Rhizotomy
- Other Surgical Treatment Options
Your treatment plan will likely start with prescription medication. The medication we use most often to treat trigeminal neuralgia is carbamazepine (also known as Tegretol or Carbatrol).
Carbamazepine is an anticonvulsant, which is used most often to treat seizures. If carbamazepine isn’t a good choice for you, your doctor may recommend another anticonvulsant. They may also try adjusting your dosage until you get the most pain relief with the fewest side effects.
As with any medication, you may experience side effects from your treatment. Side effects from carbamazepine and other anticonvulsant medications can include:
- Confusion
- Dizziness
- Drowsiness
- Fatigue
- Memory loss
- Nausea
Some people become resistant to carbamazepine therapy over time. When that happens, you’ll get less benefit from the medication even after your doctor increases your dose.
If medication doesn’t work to control your facial pain, there are surgical options, including microvascular decompression (also known as the Jannetta procedure) and glycerol rhizotomy.
Microvascular decompression (MVD), also known as the Jannetta procedure, was named after its creator, Dr. Peter J. Jannetta. Dr. Jannetta trained our surgeon, Dr. Kamal Kalia.
Before having an MVD, you’ll have an MRI (magnetic resonance imaging) exam so we can understand the cause of your trigeminal neuralgia. In most cases, trigeminal neuralgia is the result of a blood vessel making contact with the trigeminal nerve in the face. If that’s the case, you may be a good candidate for MVD.
You’ll be sedated and asleep during the MVD surgery. Your surgeon will make a small incision behind the ear on the side of your skull where you’re having pain. They’ll create a small hole in your skull through that incision and use a microscope to locate the blood vessel pressing on your trigeminal nerve. Once they find it, they’ll move the blood vessel away from the nerve and insert a Teflon pad to prevent the blood vessel from touching the nerve again.
The MVD surgery takes about two hours. You’ll stay in the hospital for two to three days to recover. Due to our vast experience with MVD, patients who have MVD surgery at Baystate usually have shorter hospital stays and recover faster.
MVD is also used to treat hemifacial spasm (face twitching or spasms on one side of the face). Your doctor may recommend surgery, oral medication, Botox® injections to treat this rare condition.
Unlike MVD surgery, glycerol rhizotomy usually only provides pain relief for one to three years. However, we can repeat it if your symptoms return.
You’ll be asleep for this procedure. Your surgeon inserts a needle into an area on your face called the trigeminal cistern, which surrounds the part of the trigeminal nerve that sends pain signals to the brain. The surgeon injects a medication called glycerol into the trigeminal cistern. That medication blocks pain signals from traveling from the trigeminal nerve to the brain.
You’ll go home a few hours after having the procedure.
You and your surgeon will work together to decide whether these procedures are right for you if you aren’t a good candidate for MVD or glycerol rhizotomy.
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