Pain Control
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Links
Facial Neuralgia/Spasm Center
This is the homepage of the Facial Neuralgia/Spasm Center that includes links to other pages as well as information about what is offered at the Medical Center.
Trigeminal Neuralgia Association
This is the home page of the Trigeminal Neuralgia Association, a nonprofit organization founded by individuals directly affected by the pain of trigeminal neuralgia, as patients or as family members of a patient.
American Chronic Pain Association
The American Chronic Pain Association offers a homepage that includes advice, pain management skills, a pain scale, catalog and other pain sites.
National Institute of Neurological Disorders and Stroke
The National Institute of Neurological Disorders and Stroke offers a patient guide to disorders that are listed on this Web page alphabetically under the heading of publications. Information on trigeminal neuralgia and hemifacial spasm is available in the alphabetical directory. This Web site also has information for professionals.
Department of Neurosurgery
This page from the Department of Neurosurgery provides links to various related diseases and conditions. |
Neurologic syndromes like trigeminal neuralgia and hemifacial spasm involve irritated cranial nerves that can cause facial spasms, tics and even extreme pain. Below are the descriptions and details of these conditions.
Trigeminal Neuralgia
Hemifacial Spasm
Trigeminal Neuralgia
Definition
Trigeminal neuralgia, also called tic douloureux, involves an intense facial pain caused by irritation of the fifth cranial nerve, which is responsible for providing sensation to the face.
In most cases, a small blood vessel may be compressing the root entry zone of the trigeminal nerve at the brainstem. Occasionally, benign tumors or multiple sclerosis can be the cause of the irritation.
Trigeminal neuralgia usually affects women older than 50. But it can also affect children and men.
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Symptoms
This syndrome can be characterized by excruciating facial pain that often radiates down the jaw. The episodes can occur spontaneously or can be triggered by light touching, chewing or changes in temperature. The pain is completely disabling.
Also, weight loss is common because oral triggers prevent affected individuals from eating enough to maintain adequate nutrition.
Diagnosis
The diagnosis of trigeminal neuralgia begins with a detailed neurological examination. MRI or magnetic resonance imaging can be used to detect sources of the problems such as benign tumors or multiple sclerosis.
Treatment
The first line of treatment usually involves anticonvulsant drugs. Anti-depressants may provide some pain relief.
For patients in whom medications are ineffective or who suffer intolerable side effects, surgery may be the answer to relieve the nerve pressure or pain.
One method is to reposition the small vessel that is irritating the trigeminal nerve. Another method is to make a partial lesion in the trigeminal nerve to produce facial numbness that is irreversible.
Alternative methods of pain relief or reduction, such as acupuncture, have helped some patients.
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Hemifacial Spasm
Definition
Facial tics or spasms on one side of the face characterize hemifacial spasm. It is thought to be caused by irritation of the seventh cranial nerve.
A small blood vessel is often found to be compressing the root entry zone of the facial nerve at the brain stem. Spasms also can be caused by a nerve injury or tumor.
Hemifacial spasms are more often found in middle-aged and older women, although it is also found in men as well.
Symptoms
The disorder typically begins with a twitching of an eye muscle. The spasm spreads down the face to lower areas and may cause the mouth to pull to the side.
The tics may not be painful and may only affect one side of the face at first.
Sometimes it can cause pain behind an ear or hearing changes.
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Diagnosis
A neurological examination is the first step, following by additional testing.
The vessel that is pressing on the nerve often is too small to be demonstrated by imaging studies such as magnetic resonance imaging (MRI), computed tomography (CAT scan) or angiography.
Treatment
Treatments may include medical therapies, such as anticonvulsants like those used to treat trigeminal neuralgia. One option is the injection of botulinum toxin into the face to produce a temporary partial paralysis, done every six months.
Microsurgery to reposition the small vessel is an effective method of treating people with this disorder to prevent tics.
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Research
Research on orafacial neuralgias includes looking at new anticonvulsant drugs, toxin injections and the physiological mechanisms of pain, as well as improvements to the major treatments for pain and nerve damage.
A major question being studied is which of the three treatments for trigeminal neuralgia works best, microvascular decompression, Gamma Knife rhizotomy or radiofrequency lesioning.
WFUBMC Approach
The Medical Center offers a multidisciplinary approach to the treatment of trigeminal neuralgia, hemifacial spasm and other similar disorders or neuralgias in its Facial Neuralgia/Spasm Center.
The three major treatments for trigeminal neuralgia are available at the Medical Center, which is one of the few places in the country that offers all three and is doing research on which all three.
For hemifacial spasm, the Medical Center offers both of the major treatments for that, microvascular decompression surgery and botulinum toxin injections.
The Facial Neuralgia/Spasm Center provides expeditious treatment because of the extreme discomfort caused by conditions like trigeminal neuralgia.
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