---
title: "Trigeminal Neuralgia"
---
## Pain Like Lightning Across Your Face
Trigeminal neuralgia has a pain pattern unlike anything else in medicine. Sudden, severe, electric-shock-like attacks of pain on one side of your face, sometimes triggered by light touch, eating, brushing your teeth, talking, smiling, or even a breeze, and sometimes coming without any trigger at all. Each attack lasts seconds to a couple of minutes. Between attacks you may be completely fine, or you may have a constant background ache.
The unpredictability is part of what makes trigeminal neuralgia so disabling. You cannot plan around something that strikes without warning. Most patients we see have tried medications first, usually carbamazepine, oxcarbazepine, or gabapentin. For many, the medications help significantly; for others they help partially with significant side effects, or stop working over time. What we offer is one specific category of options: interventional treatments that target the trigeminal nerve directly, alongside your neurologist or neurosurgeon as part of broader care.
## What Trigeminal Neuralgia Actually Is
The trigeminal nerve is the main sensory nerve of the face, with three major branches: V1 (forehead and around the eye), V2 (cheek, upper lip, upper teeth), and V3 (lower jaw, lower lip, lower teeth). Trigeminal neuralgia involves dysfunction of this nerve, producing the characteristic attacks of severe facial pain. The most common cause is compression of the nerve by a small blood vessel where it enters the brainstem; other causes include multiple sclerosis, tumors, and idiopathic cases.
Attacks are typically brief (seconds to two minutes), severe (often described as the worst pain imaginable), electric-shock-like, stabbing, or burning in quality, one-sided in distribution (most often V2 or V3), triggered by specific stimuli in many patients, and recurrent in clusters with periods of remission and flare.
## What This Page Is and Isn't
PHI is an interventional pain practice. We are not neurologists or neurosurgeons. Trigeminal neuralgia care is genuinely multispecialty, typically involving neurology for diagnosis confirmation and medication management, neurosurgery for evaluation of microvascular decompression for appropriate candidates, and radiation oncology for evaluation of gamma knife for selected patients.
PHI's role is targeted nerve blocks and radiofrequency ablation of trigeminal branches as additional options. We do not replace the neurology and neurosurgery components of trigeminal neuralgia care; we provide specific interventional procedures that may help when medications are not enough or while patients are evaluating other definitive treatment options.
## How PHI Treats Trigeminal Neuralgia
The first step is comprehensive evaluation: confirmation of your diagnosis (typically established by neurology), a detailed history of your attack pattern and triggers, review of your medication history and response, and coordination with your neurology and other specialty providers.
Trigeminal nerve blocks target the affected branch and serve multiple purposes: diagnostic (confirming which branch is involved), therapeutic (providing relief lasting weeks to months for some patients), and preparatory (confirming candidacy for radiofrequency ablation if response is positive but short-lived). Radiofrequency ablation of trigeminal branches is appropriate for selected patients whose pain involves specific branches and who have not responded adequately to medications, disrupting the pain-signaling function of the targeted branch for longer-lasting relief that can be repeated when it diminishes. PHI performs these procedures in our affiliated surgical suite under fluoroscopy. For patients whose pain has not responded adequately to medications and interventional treatments, we help coordinate neurosurgical evaluation for microvascular decompression or radiation oncology evaluation for gamma knife.
## When to See Someone
Consider professional evaluation when you have severe facial pain attacks consistent with trigeminal neuralgia, when your medications are not providing adequate relief, when side effects are limiting their use, or when you want to understand interventional options. Interventional options are typically considered after adequate medication trials, not as first-line treatment.
Seek prompt evaluation for sudden severe facial pain accompanied by other neurological symptoms, facial pain alongside facial weakness or vision changes, or new onset of severe facial pain in a younger patient, which may warrant evaluation for multiple sclerosis or other secondary causes.
## Why PHI for Trigeminal Neuralgia
## Frequently Asked Questions
**Q: How is trigeminal neuralgia different from other facial pain?**
Trigeminal neuralgia has distinctive features. The attacks are brief (seconds to minutes), severe (often the worst pain imaginable), one-sided, and electric-shock-like in quality, often triggered by specific stimuli. Other causes of facial pain such as sinus issues, dental problems, TMJ, or atypical facial pain typically have different patterns.
**Q: Should I try medications first?**
Yes, in most cases. Carbamazepine and oxcarbazepine are the first-line medical treatments and produce significant relief in many patients. PHI's interventional options are typically considered after adequate medication trials, not as first-line treatment.
**Q: What about microvascular decompression?**
Microvascular decompression is a neurosurgical procedure that addresses the most common underlying cause (compression of the nerve by a blood vessel). For appropriate candidates, it has the highest long-term success rate of any trigeminal neuralgia treatment. It is not in PHI's lane, but we coordinate with neurosurgical specialists when this evaluation is appropriate.
**Q: What about gamma knife radiosurgery?**
Gamma knife uses focused radiation to disrupt trigeminal nerve function, another option for patients who are not surgical candidates or prefer non-surgical alternatives. PHI does not perform gamma knife, but we coordinate with radiation oncology.
**Q: How effective are nerve blocks for trigeminal neuralgia?**
For appropriate responders, nerve blocks can produce meaningful relief lasting weeks to months. The relief can also be diagnostic, identifying which branches are involved. For patients with positive but short-lived responses, radiofrequency ablation often provides longer-lasting relief.
**Q: How effective is radiofrequency ablation?**
Radiofrequency ablation of trigeminal branches can provide relief lasting six months to several years for many patients, and it can be repeated when relief diminishes. It is most appropriate after a positive diagnostic block confirms the targeted branch.
**Q: Will I have facial numbness after ablation?**
Often, yes. Ablation disrupts nerve function in the targeted branch, which typically produces some degree of numbness or altered sensation in that area. Most patients consider this trade-off worthwhile given the severity of the original pain, and your physician will discuss what to expect.
**Q: Is trigeminal neuralgia curable?**
Cure is sometimes the right word and sometimes not. Some patients experience long-term remissions, particularly after successful microvascular decompression. Others have chronic management situations where medications and procedures provide significant relief but do not eliminate the condition entirely. The goal is meaningful, sustainable improvement.
**Q: Do you take insurance?**
Insurance coverage and payment options may vary. Please contact our office to discuss your specific plan, available options, and pricing. All pricing is disclosed at consultation.
**Q: Do you accept international patients?**
Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations.
## Treatments We Offer for Trigeminal Neuralgia
PHI offers evidence-based interventional treatments for trigeminal neuralgia, working alongside your neurology and neurosurgical care.
- Trigeminal Nerve Blocks, diagnostic and therapeutic for the affected branch
- Radiofrequency Ablation, longer-lasting relief after a positive diagnostic block
> Trigeminal neuralgia: new classification and diagnostic grading for practice and research. Peer-reviewed via PubMed.
— [Cruccu G, et al.](https://pubmed.ncbi.nlm.nih.gov/27306631/)
> Trigeminal neuralgia information. NIH National Institute of Neurological Disorders and Stroke.
— [NIH National Institute of Neurological Disorders and Stroke](https://www.ninds.nih.gov/health-information/disorders/trigeminal-neuralgia)
## Schedule Your Trigeminal Neuralgia Consultation
A 60-minute consultation will evaluate whether interventional treatments are appropriate for your specific situation, walk through what to expect, and coordinate with your other specialty providers. Call (310) 856-9488 or book online now.
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