Trigeminal neuralgia

Also called tic douloureux. Inflammation of the trigeminal nerve (the fifth cranial nerve) that most commonly causes paroxysms of very intense lightning pain in the areas of the face the nerve supplies -- the lips, eye, nose, scalp, forehead, gums, cheek, and chin -- on the involved side of the face. A less common "atypical" form of the disease causes a more constant, dull, burning, or aching pain. Onset is generally after age 50, but even children can be afflicted. Triggers for attacks can include touching the face, brushing the teeth, putting on makeup, and a soft breeze.

Medication is usually the first therapy employed for pain relief. Tegretol is the drug most often effective for trigeminal neuralgia pain though others such as Dilantin, Neurontin, Trileptal and Klonazepin are often a benefit to patients.

Before surgery is considered an MRI should be performed to rule out other causes of the pain. Surgical procedures include percutaneous (needle puncture through the skin) such as: glycerol rhizotomy and balloon microcompression. These techniques are most often recommended for elderly patients, patients with MS and patients who have recurrent patient following microvascular decompression. Microvascular decompression is a common procedure used on younger patients with typical trigeminal neuralgia. Gamma Knife radiosurgery may be an option in patients whose pain is refractory to medication and/or surgical intervention. Since this treatment is the least invasive procedure it is often a preferred treatment option in elderly patients who are not candidates for other forms of surgery. Gamma Knife treatment is performed by delivering a high dose of radiation in a single treatment session using multiple beams of radiation.

TNA The Facial Pain Association
http://old.fpa-support.org/aboutfp/index.html

Gamma Knife vs. Cyberknife