What Is a Trigeminal Neuroma?

Trigeminal neuroma is a disorder of the nervous system stemming from damage to the trigeminal nerve. Also known as tic douloureux, trigeminal neuroma affects a cranial nerve in the face that is primarily responsible for chewing and relaying sensory information, such as pain and pressure. Damage to this nerve can cause shooting pain in one or both sides of the face, and these painful episodes can occur many times each day. 

This condition is thought to be caused by compression of the trigeminal nerve by a blood vessel, which causes the nerve to register pain at sporadic moments and to send pain signals to the brain at times when there is no pain. Damage to the nerve is sometimes caused by other conditions, such as a tumor, cyst or aneurysm. Sometimes a facial piercing or tongue piercing can cause damage to the trigeminal nerve. 

The damage to the nerve causes the person to experience various flashes of pain without a cause, or the pain could be the result of touching the face, brushing the teeth or even talking. Air and loud sounds can also trigger an attack. This condition can be progressive, spreading to other areas of the face. The attacks will happen more frequently over time, and the pain will become more severe. 

If a person experiences this type of pain, a physician might ask about the person’s health and lifestyle to rule out any other causes. Dental issues and postherpetic neuralgia, a condition that results from complications of shingles, must be ruled out. The physician might order a magnetic resonance imaging (MRI) test to determine whether the person has a tumor, aneurysm or multiple sclerosis. There is no definitive way to diagnose a person with trigeminal neuroma. 

If a person’s physician believes that he or she has the condition, then a course of treatment will be determined. Usually, trigeminal neuroma can be treated with medications, but there are some instances in which a surgical procedure might be necessary. Anti-convulsants, antidepressants, muscle relaxers or pain relievers will be prescribed to control the painful attacks and prevent the disease from getting worse. Surgical options include stereotactic radiation therapy and balloon compression, but these procedures will cause permanent damage to the nerve to prevent it from sending any future pain signals to the brain. 

Non-surgical options can help relieve symptoms while allowing the nerve to remain intact. Glycerol can be injected into the nerve to reduce pain symptoms, and the procedure can be repeated, although with less effectiveness. Radiofrequency rhizotomy is another procedure where a radiofrequency current is used to burn pain nerve sensors. Microvascular decompression is performed to separate the enlarged blood vessel from the nerve.