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![](db+"spacer.gif?Openimageresource") Clinical Specialty
Pain / Trigeminal Neuralgia
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| PROGRAM DESCRIPTION |
Trigeminal neuralgia, also called tic douloureux, is severe facial pain — perhaps the most excruciating pain encountered in medicine. Trigeminal neuralgia is more common in women than in men. It occurs mainly in middle age and older patients. The pain is described by the patient as a sudden, excruciating, shock-like paroxysm of pain lasting a short time, usually less than a minute, although it may recur at irregular frequent intervals, sometimes with multiple repetitions of pain within a few minutes. It may arise from and spread to any part of the face. It can be triggered by eating, talking, brushing the teeth, rubbing the part of the face where the pain arises or by a cold wind. Recurrent attacks of pain usually remain localized to the area of the face in which the pain originated. The cause of trigeminal neuralgia is idiopathic in most patients. Rarely it is caused by a tumor involving the trigeminal nerve.
The diagnosis is made from the patient’s description of the pain. The electrical, lancinating quality of the pain, its unpredictable onset and its consistent location usually makes the diagnosis clear. The diagnosis is confirmed by relief of the pain with a drug called carbamazepine (Epitol, Tegretol). Services provided at Washington University School of Medicine include microvascular decompression, percutaneous procedures and Gamma Knife radiosurgery. Washington University is among few centers in the region to offer this spectrum of care.
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| CONDITIONS & TREATMENTS |
Medical Treatment
Trigeminal neuralgia does not respond to ordinary pain medications and narcotics. However, it is frequently relieved by anticonvulsant medications. Carbamazepine (Epitol, Tegretol) in doses of 100 to 200 mg three times a day is usually effective within one to two days. The appropriate dose is determined in the individual patient. The most common side effects of the drug are nausea, drowsiness, a sense of unsteadiness and an ill-defined malaise. Carbamazepine may suppress the production of blood cells and affect liver function. There is a tendency for the effectiveness of the drug to diminish with time. Phenytoin (Dilantin) is sometimes effective in relieving trigeminal neuralgia but generally it does not work as well as carbamazepine. Other drugs that might be effective in controlling the pain in some patients include lioresal (Baclofen), gabapentin (Neurontin), valproic acid and lamotrigine.
Surgical Treatment
If the pain of trigeminal neuralgia is not controlled adequately by medical therapy, there are a number of surgical procedures that can be done to alleviate the pain. The two most common procedures that we perform are microvascular decompression of the trigeminal nerve and percutaneous radiofrequency lesion of the trigeminal nerve. Vascular decompression is a major intracranial operation that can minimize the degree of facial numbness caused by the disease. The percutaneous radiofrequency procedure is not a major intracranial operation, but it requires the creation of some permanent numbness to relieve the trigeminal neuralgia. Other procedures performed for trigeminal neuralgia include glycerol injections of the trigeminal nerve, cutting branches of the trigeminal outside the skull and stereotactic radiosurgery with the Gamma Knife. With any of the surgical procedures, there is some chance that the pain will return. If this happens, these procedures can be repeated.
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| FACULTY |
Neurosurgery Providers
Joshua M. Dowling, M.D.
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| CONFERENCES |
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| MAKE AN APPOINTMENT |
Adult Patients
Contact us at (314) 362-3577 (Option 1)
Adult Referring Physicians
Contact us at (314) 362-3577 (Option 2)
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| PATIENT OFFICE LOCATIONS |
Adult Patients
Neuroscience Center
Center for Advanced Medicine
4921 Parkview Place, Suite 6C
St. Louis, Missouri 63110
Barnes-Jewish West County Office
1040 North Mason Road, Suite 211
Creve Coeur, Missouri 63141
Helpful Maps
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| SPECIALTY LINKS |
Trigeminal Neuralgia Association
NINDS Trigeminal Neuralgia Information Page
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