Trigeminal neuralgia

Trigeminal neuralgia causes sudden episodes of intense facial pain, usually on one side of the face. It can feel like an electric shock and occur when speaking, eating, washing the face, or brushing teeth. A neurosurgical evaluation confirms the diagnosis, identifies possible causes, and determines the most appropriate treatment for each patient.

Trigeminal neuralgia is a disorder that affects the trigeminal nerve, which is responsible for transmitting much of the sensation from the face to the brain. This nerve has three branches that supply the forehead and eye, the cheek, and the jaw area.

When the nerve is irritated or compressed, it can cause brief, repeated attacks of very intense pain. Although the episodes usually last from a few seconds to about two minutes, they can occur several times a day and interfere with daily activities such as eating, speaking, or performing facial hygiene.

Some people experience pain-free periods between attacks. In other cases, persistent discomfort, burning, or facial tenderness may accompany the attacks. The intensity and frequency can change over time.

Facial pain is not always caused by trigeminal neuralgia. Dental problems, temporomandibular joint disorders, migraines, sinusitis, and other neurological conditions can produce similar symptoms. For this reason, it is important to avoid self-diagnosis.

In many patients, neuralgia is related to contact with or compression of the trigeminal nerve by a blood vessel near its entry into the brainstem. Repeated pressure can damage the nerve’s protective sheath and cause abnormal pain signals.

There are also cases associated with multiple sclerosis, tumors, or other lesions that affect the nerve’s path. In some individuals, no specific structural cause is identified.

Diagnosis begins with a detailed medical history. The location of the pain, its duration, triggers, frequency of episodes, and previously used treatments are discussed. A neurological examination is also performed to assess sensation and rule out other disorders.

Brain MRI can help identify vascular compression, structural damage, or diseases affecting the nerve. However, MRI findings should always be interpreted in conjunction with the symptoms and medical evaluation.

Treatment is selected based on the type of neuralgia, pain intensity, likely cause, age, overall health, and response to previous treatments. Not all patients require surgery.

Treatment typically begins with medications that reduce pain signals from the nerve. These include certain anticonvulsants, which require a prescription, gradual dosage adjustment, and medical monitoring.

Over time, some patients may experience reduced response, require higher doses, or develop adverse effects. It is not recommended to modify or discontinue these medications without consulting a specialist, as each case requires an individualized treatment plan.

During the evaluation, I individually analyze your symptoms, the characteristics of your pain, imaging studies, and your response to previous treatments. My goal is to confirm whether you have trigeminal neuralgia, rule out other causes of facial pain, and clearly explain the available alternatives.

Each case requires careful evaluation to determine which treatment can offer the best balance between pain relief, safety, and quality of life.

Microvascular decompression aims to separate the blood vessel compressing the nerve from the nerve itself. During the procedure, a protective material is placed between the two structures to reduce contact and preserve nerve function.

This surgery may be considered when symptoms are consistent with trigeminal neuralgia, vascular compression is suspected, and the patient is a suitable candidate for neurosurgical intervention.

Unlike procedures that produce a controlled injury to the nerve, microvascular decompression attempts to correct the mechanical cause without destroying the nerve. However, it is an intracranial surgery and carries risks that must be considered.

During the evaluation, I individually analyze your symptoms, the characteristics of your pain, imaging studies, and your response to previous treatments. My goal is to confirm whether you have trigeminal neuralgia, rule out other causes of facial pain, and clearly explain the available alternatives.

Each case requires careful evaluation to determine which treatment can offer the best balance between pain relief, safety, and quality of life.