What is Trigeminal Neuralgia?

Trigeminal neuralgia is usually categorized as typical or atypical, with symptoms differing depending on the type:

•  Typical:  With typical TN, the most common form, patients suffer from unpredictable episodes of stabbing, electric shock-like pain in a consistent location.  The pain can be reproduced by touching a “trigger point” on the face or performing a certain activity, such as chewing or talking.
• Atypical:  Patients with atypical TN experience a persistent dull ache or burning sensation in one part of the face.  However, episodes of sharp pain can complicate atypical TN.  Unlike typical TN, there is often not a specific trigger point for the pain and it can grow worse over time.

Severe pain is the number one symptom associated with TN.  The devastating condition causes patients extreme, and often debilitating, pain and is commonly referred to as the “suicide disease” due to the level of excruciating pain experienced by patients who suffer from the condition.  The pain varies and may range from sudden, severe, and stabbing to a more constant, aching, burning sensation.  The pain can be triggered by vibration or contact with the cheek (such as when shaving, washing the face, or applying makeup), brushing teeth, eating, drinking, talking, or being exposed to the wind.  It may affect a small area of the face or may spread. If you experience facial pain, particularly prolonged or recurring pain or pain unrelieved by over-the-counter pain relievers, please see your physician. 

TN can be very difficult to diagnose because there are no specific diagnostic tests and symptoms are very similar to other facial pain disorders.  The condition can often be mistaken for a dental problem since the disorder usually causes sharp pain in the jaw.  Diagnosis sometimes takes several years, as patients may undergo root canals or tooth extractions in an attempt to relieve their pain.  If you experience unusual, sharp pain around the eyes, lips, nose, jaw, forehead, or scalp, and you have not had dental or other facial surgery recently, address the problem with your primary care physician.  Your physician may refer you to a specialist.  Most people with TN eventually will undergo a magnetic resonance imaging (MRI) scan to rule out a tumor or multiple sclerosis as the cause of their pain.  This scan may or may not clearly show a blood vessel compressing the nerve. Special MRI imaging procedures can reveal the presence and severity of compression of the nerve by a blood vessel.

In the treatment of TN, pain management with medication is traditionally the first line of defense.  While this approach can reduce the effects of the disorder, some patients may require or request additional treatment due to advanced pain or a desire to avoid the side effects of current medication.  In these cases, the patient may be a candidate for CyberKnife treatment.

The CyberKnife® Robotic Radiosurgery System delivers hundreds of highly concentrated and incredibly precise beams of radiation targeted directly to the trigeminal sensory nerve root, interrupting the transmission of pain signals to the brain.  The pinpoint accuracy and precision of the procedure minimize radiation exposure to surrounding tissue and provide a noninvasive treatment typically completed in a single outpatient session.

CyberKnife may be an effective treatment for TN.  Many patients reported relief shortly after completing treatment, and in some cases, pain medications were significantly reduced or no longer required.  TN does not have a cure, but pain can be reduced or eliminated in about 85 to 90 percent of patients who are treated with stereotactic radiosurgery.