Understanding the Treatment Options for Trigeminal Neuralgia

Trigeminal Neuralgia, or Tic Doulourex as it is sometimes known, is a rare neurological condition affecting approximately four people in every 100,000. It causes sudden and severe stabbing pains recurring in the face stemming from one or more branches of the trigeminal nerve. Trigeminal Neuralgia can be misdiagnosed as dental pain, but our pain specialists in Knoxville have a wealth of experience in treating the condition and can usually spot it quickly. Once diagnosed the appropriate course of action can be taken to manage the condition through medical or surgical options to relieve the sometimes-debilitating pain Trigeminal Neuralgia can cause.

Non-Surgical Treatment Options for Trigeminal Neuralgia

When it comes to treating a patient with Trigeminal Neuralgia, pain specialists in Knoxville know that medication is the first step. When dealing with nerve based pain, even the most minimally invasive surgical procedures carry risk and should always be the last resort. Following ongoing research and study, the most effective drugs for Trigeminal Neuralgia are those originally developed to treat epilepsy.

Anti-convulsant medication is commonly prescribed by pain specialists in Knoxville for treating Trigeminal Neuralgia. It is possible to provide partial, if not total pain relief for between 80 to 90 percent of patients. Muscle relaxants can also be prescribed either on their own or combined with pain relief. However, the drugs do not always remain effective over time, and a higher dosage may be needed. There can also be some unpleasant side effects including the following:

  • Dizziness
  • Drowsiness
  • Forgetfulness
  • Nausea

Surgical Treatment Options for Trigeminal Neuralgia

As briefly covered above, surgical treatments are often the last resort for Trigeminal Neuralgia. Even minimally invasive surgery can carry substantial risk. Pain specialists in Knoxville will usually reserve surgery for patients who are still experiencing debilitating pain even with the best possible pain management. If surgery is a possibility, the first step is to carry out a surgical evaluation on the patient. The evaluation will first confirm the trigeminal neuralgia diagnosis by way of an MRI, which can also eliminate other causes. The evaluating surgeon will then assess the severity of the pain, the general health and physical condition of the patient and discuss treatment goals.

The most common surgical procedure offered to Trigeminal Neuralgia patients is Microvascular Decompression (MVD). The treatment is also known as the Jannetta Procedure. The operation involves making a small incision behind the ear and drilling a hole in the skull. With the help of microscopic visualization, the trigeminal nerve is exposed. It is then possible to see if a blood vessel is compressing the nerve. If this is the case, it can be moved away from the vein, and a Teflon felt pad inserted. The pain is almost always relieved by the procedure.

MVD is considered major surgery, and as with any open-skull procedure, there are some potential risks that need to be taken into consideration. These include infection, excessive bleeding, hearing loss and stroke. When you consider the possible side effects, it is easy to understand why pain specialists in Knoxville prefer to try medical treatments before turning to surgical options.

Associated Pain Specialists (APS) has two Pain Management Clinics (one in Johnson City, TN and one in Knoxville, TN). Both locations can provide pain management options for patients including those living with chronic pain conditions. APS also operate the Smoky Mountain Ambulatory Surgery Center with its own on-site interventional pain specialist, orthopedic spine surgeon, and fellowship trained anesthesiologist.


Phone: (865) 673-5000

Please reference APS’s content disclaimer (located in this channel’s profile description) in regard to this shared content.

Is Your Dizziness a Result of Vestibular Migraine?


Up to 3% of the population are thought to suffer from a vestibular migraine. Half of these people are undiagnosed or are not being treated with the appropriate pain management because a vestibular migraine is hard to diagnose. There is no set test, but if a patient’s symptoms fit several statements about this particular migraine type, then they may be a candidate for diagnosis.

Let’s discuss some of the signs that indicate you could be suffering from a vestibular migraine.

What is a Vestibular Migraine?

First, it might be helpful to understand the definition of Vestibular Migraine. The official name is ‘migrainous vertigo’ and it is so much more than just a headache. In fact, you may not suffer headache pain at all. Some debilitating symptoms can affect your ears, vision, and balance. The most common symptom is vertigo, accompanied by dizziness and neck pain. It can be almost intolerable for sufferers to bend down or turn their head and it is not unusual to experience tinnitus (ringing in the ears) or blurred vision. These symptoms mean that finding the right pain management plan can be a challenge.

5 Signs That You May Be Suffering from Vestibular Migraine

If you find yourself agreeing with all the statements below, then you could be a likely candidate for a vestibular migraine diagnosis. Seek advice from an ENT or neurologist to discuss treatment and an effective pain management plan.

1.     You or Your Family Have a History of Migraines
Vestibular Migraines have a strong genetic component. If a relative has a history of migraines or if you already suffer from migraines, then the chance of vestibular migraine increases.

2.     You Suffer from the Symptoms of Vertigo
One of the key indicators of vestibular migraine is that you suffer from vertigo during a migraine headache. You may not necessarily have pain, which is why pain management can be tricky. Symptoms include vertigo, dizziness, motion sensitivity, poor balance, spatial disorientation, spinning and rocking. These symptoms can last from 5 minutes up to several days.

3.     Your Symptoms Can Vary in Severity
Another hallmark of a vestibular migraine is that the severity of your symptoms will change over time and worsen with exposure to migraine triggers. Some triggers (including behavioral factors, hormonal triggers, environmental factors and dietary/chemical triggers) can cause migraines. If your symptoms are steady, without fluctuation, then it is unlikely to be a vestibular migraine. If they worsen after exposure to a known trigger, then vestibular migraine is more likely.

4.     You Also Suffer Classic Migraine Symptoms

If you are suffering from a vestibular migraine, it is also common to have classic migraine symptoms simultaneously. These might include a headache, sensory sensitivity, nausea, aura and tinnitus.

5.     These Symptoms Are Negatively Impacting Your Life
If your symptoms are severe enough that they begin to reduce your quality of life, this is another strong indication that you could be suffering from a vestibular migraine. Your ability to do everyday tasks like driving, going out with friends or even walking becomes difficult. Some patients who have vestibular migraines find it difficult to even get out of bed without appropriate pain management and treatment.

Treating the Pain

A vestibular migraine is often treated similarly to a classic migraine. However, sometimes finding the correct pain management plan can be difficult since pain is not always present. Medication can be given to treat the most common symptoms and making lifestyle changes to eliminate triggers can also help.

Please reference APS’s content disclaimer (located in this channel’s profile description) in regard to this shared content.

Is Your Dizziness a Result of Vestibular Migraine?