Understanding Trigeminal Neuralgia

The fifth cranial nerve, known as the trigeminal nerve, is responsible for sensation in the face, not muscle strength. The name “trigeminal” comes from two words: “tri”, meaning three, and “geminus”, meaning paired or joined. This is because the nerve has three major branches, each supplying sensation to a different part of the face—upper, middle, and lower regions. These three branches merge together and enter the brain as a single nerve.

The term neuralgia comes from Greek, where “neuro” means nerve and “algia” means pain. Trigeminal neuralgia refers to severe facial pain caused by irritation of the trigeminal nerve.

In most patients, this pain occurs because a blood vessel presses against the trigeminal nerve at the point where it enters the brainstem. The brainstem is the area where the large brain and small brain connect, and many important nerves pass through this region. When a blood vessel repeatedly rubs or compresses the nerve at this sensitive point, it triggers intense, electric-shock-like pain.

The first line of treatment is medication, commonly drugs like carbamazepine. These medicines work by slowing down nerve signal transmission, which helps reduce or stop the pain. As long as the pain is controlled with medication, no further treatment is required.

If medications do not provide relief or cause severe side effects, other treatment options are considered. In younger patients, surgery may be performed to gently move the blood vessel away from the nerve, relieving pressure. In older patients, a specialized injection may be used to selectively damage part of the nerve to control pain. However, not every patient needs these procedures, and treatment is always tailored individually.