Trigeminal Neuralgia: Understanding And Treating A Debilitating Pain Disorder

Last Updated:October 07, 2025, 08:22 IST

Trigeminal Neuralgia affects the trigeminal nerve, responsible for sensation in the face, is felt by sudden, stabbing, electric shock–like pain that affects one side of the face

Trigeminal Neuralgia (TN) is one of the most excruciating pain disorders known to medicine. It affects the trigeminal nerve, responsible for sensation in the face, and is characterized by sudden, stabbing, electric shock–like pain that typically affects one side of the face. Even simple daily activities such as chewing, brushing teeth, talking, or feeling a light breeze can trigger intense pain episodes, severely affecting a person’s quality of life.

Because the pain often localizes to the jaw or teeth, trigeminal neuralgia is frequently mistaken for dental disease. As a result, many patients undergo unnecessary dental extractions or procedures before the correct diagnosis is made.

Dr. Anurag Aggarwal, Senior Consultant, Pain & Palliative Care Medicine Department, Fortis Hospital, Noida shares all you need to know:

Types and Causes

Trigeminal neuralgia is classified into two forms Primary (Classical) TN and Secondary TN.

• Primary TN is commonly caused by a blood vessel compressing the trigeminal nerve near its origin at the brainstem.

• Secondary TN arises due to other underlying conditions such as multiple sclerosis, tumors, or structural abnormalities in the brain.

Advanced imaging techniques, particularly MRI scans with specialized sequences like FIESTA or CISS, play a crucial role in identifying the exact cause. They help detect vascular compression and rule out other potential pathologies.

Treatment Approaches

The management of trigeminal neuralgia requires a stepwise, individualized approach.

1. Medical Therapy: Medication is the first line of treatment. Drugs such as Carbamazepine and Oxcarbazepine are considered the most effective and their positive response often confirms the diagnosis. If these medications become less effective or cause side effects such as dizziness or liver dysfunction, alternatives like Lamotrigine, Baclofen, or Gabapentin may be prescribed. However, some patients eventually develop drug resistance or intolerance, necessitating interventional options.

2. Interventional and Surgical Options: When medications fail to provide adequate relief, several advanced interventional and surgical procedures are available:

• Microvascular Decompression (MVD):

This surgical procedure involves relieving pressure on the nerve by repositioning or cushioning the offending blood vessel. It is most suitable for younger, healthier patients with clear vascular compression and often offers long-term pain relief.

• Gamma Knife Radiosurgery:

A non-invasive, outpatient treatment that uses focused radiation to target the nerve root. It avoids the need for open surgery and is ideal for patients who are not fit for major operations.

• Ablative Procedures:

Minimally invasive, day-care options such as Gasserian ganglion radiofrequency ablation (RFA), balloon compression rhizotomy, and glycerol injection can selectively interrupt abnormal pain signals. These techniques provide significant and lasting relief, especially for elderly patients or those with secondary TN, without the risks associated with open brain surgery.

Restoring Quality of Life

With timely diagnosis and a multidisciplinary treatment plan, most patients with trigeminal neuralgia can achieve excellent pain control and regain normal function. Modern advances from high-resolution imaging to minimally invasive interventions have transformed the outlook for patients suffering from this debilitating condition.

Swati Chaturvedi

Swati Chaturvedi, a seasoned media and journalism aficionado with over 10 years of expertise, is not just a storyteller; she’s a weaver of wit and wisdom in the digital landscape. As a key figure in News18 Engl…Read More