Trigeminal Neuralgia
Trigeminal neuralgia is a chronic pain condition affecting the trigeminal nerve, one of the most widely distributed nerves in the head. Often described as one of the most painful conditions known to medicine, it causes sudden, severe, electric shock-like facial pain that can be triggered by everyday activities such as eating, speaking, or even a light touch.
Dr Joseph Garcia Redmond provides expert evaluation and treatment of trigeminal neuralgia, offering the full spectrum of treatment options from medical management to advanced surgical interventions. His fellowship training in skull base surgery at Toronto Western Hospital and specialized Gamma Knife radiosurgery training at the Cleveland Clinic enable him to offer both microvascular decompression and radiosurgery for this challenging condition.
Dr Garcia Redmond understands the profound impact trigeminal neuralgia has on quality of life. His approach emphasizes accurate diagnosis, effective medical management, and when surgery is needed, using the most appropriate technique to provide long-lasting pain relief while preserving normal facial sensation.
What is Trigeminal Neuralgia?
Trigeminal neuralgia (TN), also called tic douloureux, is a chronic pain disorder affecting the trigeminal nerve (the 5th cranial nerve), which carries sensation from the face to the brain. The condition causes sudden, severe, stabbing or electric shock-like facial pain.
The Trigeminal Nerve:
The trigeminal nerve has three main branches that supply sensation to different areas of the face:
V1 (Ophthalmic): Forehead, eye, and upper eyelid
V2 (Maxillary): Cheek, upper lip, upper teeth, and gums (most commonly affected)
V3 (Mandibular): Lower lip, lower teeth, gums, and jaw
Types of Trigeminal Neuralgia:
Classical (Type 1) Trigeminal Neuralgia:
Sharp, stabbing, electric shock-like pain
Brief episodes lasting seconds to minutes
Pain-free intervals between attacks
Usually caused by compression of the nerve by a blood vessel
Responds well to medications initially
Atypical (Type 2) Trigeminal Neuralgia:
More constant, burning, or aching pain
May have sharp episodes superimposed on background pain
Less responsive to medications
More challenging to treat
Secondary Trigeminal Neuralgia: Caused by underlying conditions such as multiple sclerosis, tumors compressing the nerve, or injury. Requires treatment of the underlying cause.
The vast majority of cases are classical trigeminal neuralgia caused by compression of the trigeminal nerve by a blood vessel (usually an artery) at the point where the nerve enters the brain stem.
The information on this website is intended as a general guide and should not replace professional medical advice. Every patient's situation is unique. Please schedule a consultation with Dr Garcia Redmond for personalised assessment and recommendations.
What Are the Symptoms of Trigeminal Neuralgia?
Characteristic Pain Features:
Sudden, severe, stabbing pain often described as electric shocks or lightning bolts
Brief episodes typically lasting seconds to 2 minutes
Multiple episodes throughout the day (can range from a few to dozens)
Unilateral (one-sided) pain affecting the right or left side of the face
Location: Most commonly affects the cheek, upper or lower jaw, teeth, or gums; less commonly the forehead or eye area
Triggering factors: Pain often triggered by light touch to the face, chewing or eating, speaking or smiling, brushing teeth, shaving, cold wind on the face.
Trigger zones: Specific areas on the face that, when touched, provoke an attack
Pain-free intervals: Between attacks, there is typically no pain (in classical TN)
Patterns and Progression:
Pain often follows the distribution of one or two branches of the trigeminal nerve
Episodes may occur in clusters with remission periods lasting weeks, months, or even years
Over time, remission periods often become shorter and pain may become more frequent
Some patients develop constant background pain in addition to sharp attacks (transition to atypical TN)
Pain does not typically occur during sleep
Impact on Daily Life:
The severity and unpredictability of pain can significantly impact quality of life:
Difficulty eating (fear of triggering pain)
Weight loss from avoiding eating
Poor dental hygiene (fear of triggering pain when brushing)
Social isolation and withdrawal
Depression and anxiety
Inability to work during severe episodes
How is Trigeminal Neuralgia Diagnosed?
Diagnosis is primarily based on your description of symptoms, as there is no specific test for trigeminal neuralgia.
Dr Garcis Redmond will undertake a Clinical Assessment including a detailed history of your symptoms, neurological examinations, and may request imaging studies inclduing high-resolution MRI with special sequences to visualise the trigeminal nerve and identify vascular compression. Imaging will also rule out secondary causes (tumors, MS plaques, arteriovenous malformations), and plan surgical approach if needed.
Differential Diagnosis:
Other conditions that may mimic trigeminal neuralgia:
Dental problems (tooth abscess, temporomandibular joint disorder)
Atypical facial pain
Glossopharyngeal neuralgia
Cluster headaches or migraines
Sinus disease
Multiple sclerosis
Dr Garcia Redmond will carefully evaluate your symptoms and imaging to ensure accurate diagnosis and appropriate treatment planning.
How Do You Treat Trigeminal Neuralgia?
Treatment typically begins with medications, with surgery reserved for patients who don't respond adequately to medical management or cannot tolerate medication side effects.
Surgical Treatment Options
Microvascular Decompression (MVD): This is the only treatment that addresses the underlying cause of trigeminal neuralgia—compression of the nerve by a blood vessel. Dr Garcia Redmond's fellowship training in skull base surgery provides extensive experience in this delicate microsurgical procedure.
Gamma Knife Radiosurgery: Dr Garcia Redmond's specialised training in Gamma Knife radiosurgery at the Cleveland Clinic enables him to offer this non-invasive alternative. Radiation causes gradual changes in the nerve that reduce pain signals. Effects develop over weeks to months.
Percutaneous Procedures: Several minimally invasive procedures can be performed by pain specialists or neurosurgeons. These include Radiofrequency thermocoagulation, Balloon compression and Glycerol injection. These procedures cause intentional nerve damage to reduce pain but result in facial numbness. They may be options for patients not suitable for MVD or Gamma Knife, or as temporary relief while awaiting other treatment.
Dr Garcia Redmond will discuss all treatment options and help you choose the approach most appropriate for your specific situation, considering your age, health, type of trigeminal neuralgia, and treatment goals.
Frequently Asked Questions About Trigeminal Neuralgia
What Are the Risks Associated with Trigeminal Neuralgia and Its Treatment?
Risks of Untreated Trigeminal Neuralgia: Increasing pain frequency and severity, reduced response to medications over time, significant impact on quality of life, difficulty eating and maintaining nutrition, poor dental health, social isolation and withdrawal, depression and anxiety, inability to work or perform daily activities.
Risks of Medical Management:
Common Side Effects: Drowsiness and fatigue, dizziness and unsteadiness (increased fall risk), cognitive slowing or confusion, nausea
Serious Side Effects (Rare): Blood count abnormalities (carbamazepine—requires monitoring), liver problems, severe allergic reactions
Microvascular Decompression Risks: MVD is generally very safe when performed by experienced neurosurgeons, but all surgery carries risks including cerebrospinal fluid leak (5-10%) - usually managed with bed rest or simple repair, headache in the surgical area (typically resolves over days to weeks), temporary dizziness or imbalance (usually resolves within days to weeks).
Less Common Complications:
Facial weakness (2-4%, usually temporary)
Facial numbness (<5%, usually mild)
Hearing loss (1-3%, ranges from partial to complete)
Double vision (rare, usually temporary)
Infection or meningitis (rare, <1%)
Cerebrospinal fluid leak requiring surgical repair (rare)
Serious Complications (Rare <1%):
Stroke
Significant bleeding
Hematoma requiring evacuation
Death (extremely rare, <0.2% in experienced centers)
Outcome Risks:
Recurrent pain (10-20% over 10 years)
Immediate failure to relieve pain (5-10%)
Need for additional procedures
Gamma Knife Radiosurgery Risks:
Gamma Knife is generally very well-tolerated with fewer risks than open surgery. Common effects include facial numbness (20-30%, usually mild and well-tolerated), tingling sensations in the face.
Less Common:
Bothersome facial numbness requiring treatment (rare)
Delayed pain relief (may take months)
Incomplete pain relief requiring additional treatment
Pain recurrence (higher rate than MVD)
Rare Complications:
Severe trigeminal nerve damage
Other cranial nerve effects
Anesthesia dolorosa (painful numbness)—very rare
Percutaneous Procedure Risks:
These procedures intentionally damage the nerve, so numbness is expected.
Dr Garcia Redmond will discuss your individual risk profile based on your specific condition, age, and overall health. In experienced hands, both MVD and Gamma Knife have excellent safety records and high success rates.
Is trigeminal neuralgia a progressive disease?
Trigeminal neuralgia typically progresses over time in that pain episodes become more frequent and remission periods shorter. However, it doesn't cause progressive nerve damage or spread. With treatment, the natural progression can be halted. Early surgical intervention may prevent the transition from classical to atypical trigeminal neuralgia.
Can trigeminal neuralgia go into remission?
Yes, spontaneous remissions can occur, especially early in the disease. Patients may experience months or even years without pain between active periods. However, pain typically returns and remissions tend to become shorter over time. This unpredictable pattern is one reason why some patients prefer definitive surgical treatment rather than waiting for remissions.
Which is better - Microvascular Decompression or Gamma Knife?
Neither is universally "better"—the optimal choice depends on individual factors. MVD offers the highest cure rate (80-90%) and most durable results, making it ideal for younger, healthy patients seeking long-term solution. Gamma Knife is excellent for elderly patients, those with medical conditions making surgery risky, or those preferring non-invasive treatment. Dr Garcia Redmond will help you weigh the benefits and risks of each approach for your specific situation.
How long does microvascular decompression surgery take?
The surgery typically takes 2-3 hours, though this varies depending on anatomy and complexity. Most of this time is spent carefully exposing and identifying the nerve and blood vessels, and ensuring complete decompression. Despite the time in the operating room, most patients are surprised by how well they feel afterward and how quickly they recover.
Can trigeminal neuralgia come back after successful treatment?
Yes, recurrence is possible with any treatment. After MVD, about 10-20% experience pain recurrence over 10 years, though many recurrences can be managed with brief medication use or repeat procedures. Gamma Knife has somewhat higher recurrence rates. Medical management frequently loses effectiveness over time. Recurrent pain doesn't mean the initial treatment failed—it may mean years of good relief before requiring additional treatment.
Will I have facial numbness after treatment?
After MVD, the goal is to preserve completely normal facial sensation, which is achieved in most patients. Mild numbness occurs in less than 5% after MVD. Gamma Knife causes mild facial numbness in about 20-30% of patients, usually well-tolerated. Percutaneous procedures intentionally cause numbness to reduce pain. Preservation of normal sensation while achieving pain relief is a major advantage of MVD.
How soon can I stop my medications after surgery?
After successful MVD, medications can typically be tapered gradually over weeks to months. It's important not to stop suddenly, especially if you've been on carbamazepine or oxcarbazepine for a long time. Dr Garcia Redmond will provide a tapering schedule. After Gamma Knife, medications are continued until pain relief develops (usually weeks to months), then gradually reduced.
What causes trigeminal neuralgia?
Most cases of classical trigeminal neuralgia are caused by compression of the trigeminal nerve by a blood vessel (usually an artery) at the point where the nerve enters the brain stem. This compression damages the nerve's protective coating, causing abnormal nerve signals perceived as pain. Less commonly, TN is caused by multiple sclerosis, tumors, or injury. In many cases, there's no clear reason why the blood vessel came to compress the nerve.
Can dental work cause or worsen trigeminal neuralgia?
Dental work doesn't cause trigeminal neuralgia, though TN pain is often initially mistaken for dental problems. However, dental procedures can trigger TN pain in someone who has the condition. Some patients undergo multiple unnecessary dental treatments before TN is correctly diagnosed. If you have unexplained facial pain, especially if dental treatments haven't helped, evaluation for trigeminal neuralgia is important.
Is trigeminal neuralgia hereditary?
Trigeminal neuralgia is generally not considered hereditary, though rare familial cases have been reported. Most cases occur sporadically without family history. Having a family member with TN doesn't significantly increase your risk of developing it.
Why Choose Rivercity Brain & Spine for Trigeminal Neuralgia Treatment?
Subspecialty Expertise: Dr Garcia Redmond's fellowship training in skull base surgery at Toronto Western Hospital included extensive experience in microvascular decompression for trigeminal neuralgia and other cranial nerve compression syndromes.
Gamma Knife Certification: Specialized training in Gamma Knife radiosurgery at the Cleveland Clinic enables Dr Garcia Redmond to offer both surgical and non-invasive treatment options.
Complete Treatment Spectrum: Expertise in both MVD and Gamma Knife means your treatment choice is based on what's best for you, not limited by available expertise.
Advanced Microsurgical Techniques: Use of high-magnification operating microscopes and modern neurosurgical technology for safe, effective nerve decompression.
Individualized Treatment Planning: Careful consideration of your age, health, type of trigeminal neuralgia, and goals to recommend the most appropriate treatment.
Multidisciplinary Approach: Collaboration with neurologists and pain specialists for comprehensive medical management before and after surgical treatment.
Experience in Complex Cases: Management of recurrent trigeminal neuralgia, atypical presentations, and cases with previous failed treatments.
Patient Education and Support: Clear explanation of options, realistic outcome expectations, and ongoing support throughout treatment.
SCHEDULE A CONSULTATION
Neurosurgery Brisbane
If you're experiencing severe facial pain and suspect trigeminal neuralgia, or if your current treatment is no longer providing adequate relief, expert evaluation can help determine the best path forward.
Contact Rivercity Brain & Spine today to schedule your consultation.