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Five things you should know about trigeminal neuralgia

University of Minnesota Health Neurosurgeon Andrew Grande, MD, shares information regarding the diagnosis and treatment of trigeminal neuralgia, a rare and excruciating nerve disorder.
Members of the University of Minnesota Health facial pain care team help treat patients diagnosed with trigeminal neuralgia, a rare and extremely painful nerve disorder that affects the trigeminal nerve, which transmits signals from the brain to the face.

Imagine having a root canal without local anesthesia.

What if that pain came back on a regular basis? What if each episode was a little worse than the last? And what if it was triggered by ordinary activities—shaving, brushing your teeth, eating or even smiling?

Welcome to the real-life difficulties experienced by people diagnosed with trigeminal neuralgia (TN), a rare and excruciating disorder caused by an abnormality in the trigeminal nerve, which transmits signals from the brain to the face.

“People describe it as the worst pain imaginable,” said University of Minnesota Health Neurosurgeon Andrew Grande, MD, who specializes in the diagnosis and treatment of trigeminal neuralgia.

To help alleviate that pain, Grande and fellow M Health neurosurgeons have established a multi-disciplinary treatment program. In the vast majority of those cases, they’re able to help people diagnosed with the condition go on to live normal, mostly pain-free lives. We asked Grande to tell us five things you should know about trigeminal neuralgia.

Trigeminal neuralgia is extremely rare.

Only about 12 out of every 100,000 people are diagnosed with TN in any given year, so you’re not likely to get it. But the condition’s rarity can also be part of the problem, Grande said. Most people with TN have never met another person with it. Because they are unfamiliar with the disease, TN patients are often misdiagnosed or have difficulty finding a specialist experienced treating the disease. Trigeminal neuralgia can strike anyone, but it’s most common in people older than 50. And the disease is more common in women than men.

Learn how our multi-disciplinary care resolved trigeminal neuralgia in a young patient.

Researchers are still digging into the cause of some cases of trigeminal neuralgia.

In many cases, TN is caused when a nearby artery becomes compressed against the trigeminal nerve. Over time, the proximity of the artery can wear away the myelin sheath protecting the nerve, causing the pain. In these instances, Grande said, surgeons are able to correct the problem by moving the artery away from the nerve. That isn’t universally true, however, and researchers believe an underlying problem in the nerve or the sheath protecting the nerve may trigger the condition.

There are a variety of treatments to alleviate trigeminal neuralgia.

Typically, the first line of defense against TN is medication. Anti-epileptic drugs, intended to prevent seizures, often work well. However, such medication can also produce side effects—drowsiness, dizziness, mental slowness—that some people find intolerable. There are a variety of surgical options for those who find medication ineffective or problematic. Options include procedures to relieve pressure on the nerve or to intentionally damage it, which interferes with the nerve’s ability to transmit painful sensations.

Read about 83-year-old Clair Bartels, who was diagnosed with and sought treatment for trigeminal neuralgia.

University of Minnesota Health is uniquely positioned to treat trigeminal neuralgia.

M Health’s multi-disciplinary approach to medicine is especially beneficial for people with TN, who may also need help managing TM-related complications. In addition to Grande, M Health’s TN team includes an ear, nose and throat surgeon; a neuro-radiologist; a dentist devoted to the treatment of facial pain; a psychologist specializing in pain management; and a pharmacist, among others.

“Our goal is not only to help people become pain free, but to keep them pain free,” Grande said. “If we try one solution and there is a recurrence of pain, we have a Plan B, a Plan C and a Plan D.”