It is thought that trigeminal neuralgia can be caused by a diverse variety of factors, some of which damage the myelin sheath that covers the trigeminal nerve. These can be:

 Result of aging
 Aneurysm (rare)
 Arteriovenous malformation
 Stroke
 Surgical injury
 Facial injury/trauma
 Multiple Sclerosis
 Postherpetic neuralgia (shingles)

Sphenopalatine Ganglion Block – The sphenopalatine ganglion is a small organ no bigger than a piece of corn that is buried inside the skull.  Amongst other things, it is responsible to conveying pain from the face into the brain.  By applying a small amount of local anesthetic onto it, one can effectively stop pain signals from reaching the brain.  If the block is successful, you doctor may recommend RFA to provide long lasting pain relief.  This procedure is quite effective for a variety of types of facial pain – meaning even if the exact diagnosis is unknown or just unclear, it can still work!

Gasserian Ganglion Block – The gasserian ganglion (better known as the trigeminal ganglion) is the meeting point for the 3 branches of the trigeminal nerve.  This ganglion has been implicated in a variety of facial pain syndromes as well as the dreaded Trigeminal Neuralgia.  Using X-ray imaging, local anesthetic is injected onto the ganglion, blocking it from sending pain signals to the brain.  In cases where the relief is only temporary, RFA may be the next step.

Stellate Ganglion Block – The stellate ganglion is an important part of the sympathetic nervous system and is well-known for its role in transmitting pain.  A small amount of a special long-acting local anesthetic called Bupivacaine is injected near the ganglion using Ultrasound-Guidance to stop the pain signals from reaching the brain.

Neurolysis & Ablation – In cases where an injection provides only temporary relief, neurolysis or neuroablation can be utilized to increase the duration. There are several different methods that can be used:

• Radiofrequency Ablation (RFA) – Radio waves are applied to a nerve or plexus, preventing the transmission of pain.
• Cryoablation – Similar to RFA, however cold temperatures are applied to the area instead of radio waves.
• Chemodenervation – The premise is the same as cryoablation and RFA in that the goal is to prevent a nerve or plexus from transmitting pain; rather than applying mechanical stress to the nerve through radiowaves or cold temperatures, small amounts of either alcohol or phenol are injected to block the nerve’s ability to transmit a signal.

IV Infusion Therapy – An increasingly popular procedure for treating a variety of pain syndromes, as well as depression and anxiety. Patients are hooked up to an IV and special medications are administered intravenously. The infusions can take as little as 30 minutes to complete.

Spinal Cord Stimulation (SCS) – This is a commonly performed procedure for a variety of pain syndromes. SCS utilizes technology similar to that of cardiac pacemakers whereby small electrodes are placed into the epidural space near the spinal cord. These electrodes will produce a small electrical current over the spinal cord that interfere with pain signals. In the case of trigeminal neuralgia pain, the leads can placed in the at the top of the cervical spine where parts of the trigeminal nerve extend into the spinal cord.  Stimulation here can stimulate nerves from the back of the head as well as the face.

Peripheral Nerve Stimulation – The premise is similar to SCS but rather the leads are placed under the skin in the area of the pain. The leads are extremely thin and are totally unnoticeable.  Those suffering with facial pain, atypical facial pain, and most importantly – trigeminal neuralgia, 1 to 2 leads are placed under the skin along the branch of the trigeminal nerve(s) in the exact region of the pain from behind the hairline making it completely scarless.