There are fewer than 20,000 trigeminal neuralgia (TN) cases every year in the US. However, the true amount is likely higher due to TN initially producing symptoms that can be easily confused with ailments like toothaches and headaches/migraines. Aching or burning, mild-to-moderate pain in the face, jaw, gums or teeth are common early symptoms associated with TN.
In contrast to other pain disorders, however, TN inevitably progresses to classic patterns of discomfort generally described as intense, sudden, shock-like pain in one side of the face that lasts for seconds to a few minutes.
Mary Mullowney, 74, was only diagnosed with TN after seeing several specialists about her symptoms. She experienced severe pain in her teeth for over a year before meeting Tony Asher, MD, director and neurosurgeon at Carolinas HealthCare System Neurosciences Institute, part of Atrium Health.
As Mary’s facial pain also included pain in her teeth, she first visited a dentist and then an endodontist (a specialist of the soft inner tissue of the teeth), hoping to find relief.
“I kept fighting it, thinking it was going to get better, and it just got worse,” she says.
During her third visit, Mary’s endodontist mentioned the term ‘neuralgia’ after reviewing her X-rays and determining that her teeth weren’t the source of the pain. She didn’t think much of it until ‘neuralgia’ was brought up again by her son, Michael Mullowney – who happens to be vice president of Carolinas HealthCare System Neurosciences Institute.
A Painful, But Timely, Episode Strikes
Michael was visiting his mother for Christmas in 2014 when suddenly Mary had an extremely painful episode before his eyes. She experienced severe pain in her tongue, which made speaking difficult. Once the episode passed, she described the excruciating pain to her son.
Michael, who was familiar with the symptoms associated with TN, due to his neurosciences work, immediately mentioned that potential diagnosis to his mother.
“Then Michael said that he knew a doctor who could take care of me,” recalls Mary. “My son basically gave me a diagnosis before even seeing Dr. Asher.”
TN Diagnosis and Life-Changing Surgery
Dr. Asher, who has treated over 1,000 TN cases to date and is among the most experienced surgeons treating TN in the Southeast, confirmed Mary’s diagnosis of TN in January 2015.
“Trigeminal neuralgia is one of the most painful disorders known to man and is incredibly debilitating,” says Dr. Asher. “Fortunately, the majority of these patients can obtain substantial or even complete relief with medical or surgical therapies.”
The first treatment option is typically medication, which initially gives many patients relief. Unfortunately, medical therapies generally offer only temporary relief and in some instances, such as Mary’s, produce no significant benefit.
“Even when we can help people with medicines, ultimately, many people with trigeminal neuralgia require some type of surgical intervention,” Dr. Asher says.
Four months after her diagnosis, Dr. Asher successfully performed microvascular decompression surgery on Mary. And for three years now, she has been pain free.
Microvascular Decompression Surgery
The pain of classic TN is thought to be activated by an artery in the brain compressing the trigeminal nerve in up to 80 percent of patients. The presence of such a blood vessel can be visible on a specific type of MRI scan, which was the case for Mary.
As shown in the video below, Dr. Asher performs microvascular decompression surgery to relieve the pain by inserting a sponge-like device in between the artery and the trigeminal nerve. By separating the artery and the nerve, the TN pain is relieved in the vast majority of patients.
