Trigeminal Neuralgia

Trigeminal neuralgia is a specific syndrome of brief, severe, electric or stabbing pain in the face — usually in the cheek or jaw on one side. The pain is triggered by light touch, chewing, talking, brushing teeth, or even a cool breeze. It typically lasts seconds, comes in clusters, and can be devastating.

The most common cause is a normal blood vessel — usually an artery — pressing on the trigeminal nerve right where it exits the brainstem. This vascular contact damages the nerve's insulating myelin and causes the firing pattern that creates the pain.

The diagnosis is clinical — the story of the pain is usually distinctive. We obtain an MRI with specialized sequences to look for vascular compression and to rule out other causes (multiple sclerosis, tumor).

Medical therapy with carbamazepine or oxcarbazepine is the first line and is very effective for most patients, at least initially. Over time, many patients develop side effects or diminished response, and the conversation turns to procedural options.

Three procedural paths are commonly considered: microvascular decompression (MVD), stereotactic radiosurgery, and percutaneous procedures (glycerol injection, balloon compression, radiofrequency ablation). The right choice depends on your age, medical history, MRI findings, and what trade-offs you are willing to accept between durability, invasiveness, and side-effect profile.

A procedural option is considered when medical therapy is failing — either because the pain has broken through or because the side effects of medication are no longer tolerable.

Microvascular decompression has the highest rate of long-term pain freedom and preserves facial sensation, but it is the most invasive option (a small craniotomy behind the ear). Radiosurgery is non-invasive but takes weeks to take effect and has lower long-term durability. Percutaneous procedures are quick and effective but typically involve some facial numbness as part of the trade-off. We walk through each one carefully before any decision.