trigeminal neuralgia
The trigeminal nerve as viewed from above on an imaging scan. In trigeminal neuralgia (TN), pain occurs in one of the nerves three branches causing excruciating pain for sufferers. (Photo: Hodaie Lab)

You'd be forgiven if you asked yourself what Trigeminal neuralgia is, as it is not a disease that is particularly well known.

To raise the profile of the facial pain disorder, Sunday, Oct. 7, is the sixth annual International Trigeminal Neuralgia Awareness Day. To mark the day, the CN Tower, the Toronto sign at City Hall, and many major landmarks around the world, from the Sydney Town Hall in Australia to the Electric Tower in Buffalo and the Sails at Canada Place in Vancouver, will light up in the colour teal.

Here's what you need to know about trigeminal neuralgia and What UHN is doing about it.

What is trigeminal neuralgia?

Trigeminal neuralgia (TN) is a facial pain disorder where repeated pain occurs on one side of the face due to a problem with one of the three branches of the trigeminal nerve. This nerve, about three millimetres wide, brings sensation information from the face to the brain.

How severe is TN pain?

Also known as "tic douloureux" (painful tic), TN is characterized by sufferers contracting their facial muscles or wincing in pain due to severity of the pain.

TN pain can happen at any time and causes sharp, piercing pain that lasts from several seconds to several minutes – some sufferers report experiencing 100 of these episodes per day. Patients have described the pain as electric and likened it to having a taser gun to the face.

Although TN pain isn't life-threatening, it can be incapacitating. For example, some people with TN are afraid to eat as the pain can be triggered by chewing.

What causes TN?

The most common cause of TN is a blood vessel pressing on the trigeminal nerve inside the skull, medically known as "neurovascular compression." Other less common causes of TN are multiple sclerosis (MS) or a tumour.

TN can affect anyone but occurs more frequently in people over the age of 50 and is more common among women than men.

According to the National Institute of Health in the United States, this disorder affects approximately 12 out of every 100,000 people per year.

Can you treat TN and how?

TN can greatly interfere in everyday activities so it is important to treat it as soon as possible.

Because episodes of TN pain occur in the facial nerves, most pain medication is ineffective. However, anti-seizure medication can be helpful as it stabilizes nerve endings.

If medication doesn't provide relief, TN sufferers who are good candidates can undergo surgery to relieve pressure on the trigeminal nerve:

  • Microvascular decompression, where pieces of Teflon are placed to separate the nerve from the blood vessel after making a small incision behind the ear.
  • Gamma Knife radiosurgery, where highly focused beams of radiation are used to treat a target location of the nerve. The radiation affects the nerve and stops the pain, but sensation is typically left intact.

Neurosurgeons at UHN's Toronto Western Hospital (TW) provide all options for treatment of TN, focusing on individualized treatment to obtain the best response.

How is UHN helping patient with TN?  

TW neurosurgeon Dr. Mojgan Hodaie specializes in both treatment and study of TN to better help its sufferers. Her research lab focuses on understanding this disorder using advanced brain imaging and has published key articles that change the way we look at this disorder. By using brain images of each patient, the research team unravelled key signatures in the central nervous system that relate to pain, which can serve to inform surgical decisions.

Dr. Hodaie's team also investigates the differences between different types of TN. For example, patients with multiple sclerosis (MS) are at higher risk of developing TN but develop a type that develops differently than it would in someone without MS.

However, there are many things about TN that are not yet fully understood. Questions such as why some individuals respond better to certain treatments than others – a subject Dr. Hodaie's lab is also looking into. Research in this area is very active, and better treatment will come with greater recognition of this disease.​

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