Dr. Eseonu (Neurosurgery Clinical Assistant Professor UPMC Neurological Institute, UPMC Neurosurgery) talks about Trigeminal Neuralgia. Dr. Eseonu explains what trigeminal neuralgia is, its symptoms, and treatments.
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Trigeminal Neuralgia
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Chikezie Eseonu, MD
Chikezie Eseonu, MD, specializes in spine surgery and is certified in neurological surgery by the American Board of Neurological Surgery. He practices at UPMC Neurosurgery and is affiliated with UPMC Harrisburg, UPMC Community Osteopathic, UPMC Hanover, UPMC West Shore, UPMC Carlisle, UPMC Memorial, and UPMC Lititz. He completed his residency program at Johns Hopkins Hospital and medical degree at Yale University School of Medicine. Transcription:
Bill Klaproth (host): So are you experiencing painful sensation similar to an electric shock on one side of your face or your forehead or other types of stabbing pains in your face? I'll tell you, this can be scary and painful. It could be trigeminal neuralgia. So let's learn more about that with Dr. Chikezie Eseonu, neurosurgery clinical assistant professor with UPMC Neurological Institute and UPMC Neurosurgery.
This is Healthier You, a podcast from UPMC. I'm Bill Klaproth. Dr. Eseonu, thank you so much for your time. This is really an interesting topic. Looking forward to talking to you about this. So first off, just so we all know, what is trigeminal neuralgia?
Dr. Chike Eseonu: Yeah, thank you for having me. The trigeminal neuralgia is a facial pain syndrome affecting the trigeminal nerve. The trigeminal nerve is a nerve that controls mainly the sensation of your face. and when you have any issue with it in the form of trigeminal neuralgia, it can cause sharp stabbing-like pains normally on one side, sometimes on both sides of your face, that are pretty severe, you know, leaving patients in extreme pain with inability to speak, eat, chew or even smile.
Bill Klaproth (host): Wow. Okay. So the symptoms are pain, inability to eat, speak, or even smile. Are there other symptoms someone should be aware of?
Dr. Chike Eseonu: Yeah. It normally comes in two different types, either a typical trigeminal neuralgia or atypical. The typical one is that sharp stabbing pain. It can be either in your forehead, your cheek, your lower jaw, or kind of a combination of one of those three. And it lasts normally for a minute or two, can self-resolve, but then can constantly come back.
The atypical form tends to be not so much a stabbing pain, but more of a dull burning pain, again, normally on one side of your face that again is a little more constant. Normally, that's the main presenting feature for that syndrome. And then, you can imagine if your teeth hurt, your face also hurts, it can be difficult do a lot of things.
Bill Klaproth (host): I imagine it must be scary too, I'll say, and you're getting this sharp stabbing pain, you know, across your face or your forehead or the dull aching sensation, someone might feel like, "What is going on with me? What is this?" So I bet it's scary as well. Do we know what causes this, Dr. Eseonu?
Dr. Chike Eseonu: Yes. Normally, it's an issue with the trigeminal nerve itself. And this issue can present from something compressing on the nerve, whether it's a tumor, whether it's a blood vessel. Sometimes the issue of multiple sclerosis can cause some deformities in the outer surface or the protective covering of the nerve called myelin. And then, it makes it for a defective nerve. And when you have a defective nerve, instead of doing its normal job of giving you sensation to your face, it starts shooting out abnormal signals that present themselves as the sharp facial pain.
Bill Klaproth (host): Where is the trigeminal nerve located?
Dr. Chike Eseonu: So it's in the kind of middle center part of your brain called the brainstem. Essentially, if you started kind of from your nose and kind of started working your way deep into your head, that's sort of where the brain stem is located. And it generates from there and moves through the facial bone into the surface of your facial skin. And that's kind of the pathway of the trigeminal nerve.
Bill Klaproth (host): So, how do you diagnose this? Is this this with MRI or x-ray or physical examination? How do you diagnose it?
Dr. Chike Eseonu: Yeah. Normally, it's a diagnosis of symptoms. If you're having the type of pain that I had mentioned earlier, that normally can get you a diagnosis of trigeminal neuralgia. And then, you can use imaging studies, like an MRI scan of the brain to evaluate what the nerve itself looks like, whether there is compression on the nerve or whether they're just some visible abnormality of the nerve that may explain the issue.
Bill Klaproth (host): So then, once it is determined that the person is suffering from trigeminal neuralgia, how do you treat this?
Dr. Chike Eseonu: There's multiple methods of treatment. The first-line method is medication-based, and this can be either through your primary care physician, or you may have a specialized neurologist who works with this condition. And the medications tend to be either antiseizure medication. There's some kind of antidepressant medications that also can help with the pain, but tends to be fairly effective in normally 90% of people.
If for whatever reason you're not able to tolerate the medication, it's making it too sleepy or you're just not functioning properly on them, the next line of treatment, comes into my room of neurosurgery where it could be a surgical intervention where either I look to try to decompress the nerve, whether if it's being compressed by a tumor or some vessel. Or there's some simpler procedures that are less invasive, such as one's called a trigeminal rhizotomy, which is an outpatient procedure where you essentially get an injection into the trigeminal nerve to try to control the pain. Or the third line would be radiation treatment where we target radiation to that trigeminal nerve in an attempt to try to cool down or kill off those bad nerves that are causing the pain.
Bill Klaproth (host): So with treatment, what is the longterm prognosis for someone with trigeminal neuralgia? You said medication, I think, is effective 90% of the time. There's also surgical intervention. And then, you said there's less invasive methods. How well do these treatment options work?
Dr. Chike Eseonu: The overall treatment is very effective. But again, usually mainly on the word treatment, meaning, you know, it is a lifelong condition that's managed when it is managed with medications. There are certain situations where if that nerve is compressed by something and you undergo an open surgery to decompress the nerve, that can be more of a curative treatment as long as that decompression remains. But then, the others are again treatments, but can reduce, if not eliminate, your facial pain for long durations of time and allow you to live a normal life while you're being managed for the condition.
Bill Klaproth (host): So it sounds like this doesn't go away on its own.
Dr. Chike Eseonu: Correct. You may have intervals of no pain, which can last hours, can last days, can even last up to years, but it will recurrently come back from time to time over time without any specific treatment.
Bill Klaproth (host): Yeah. Are there certain risk factors involved in this?
Dr. Chike Eseonu: No specific risk factors as far as genetics go or any indications of lifestyle that may predispose you to trigeminal neuralgia. Overall, women tend to be more likely to have trigeminal neuralgia than man and with a 2:1 ratio. Also, age, you know, around the age of 50 tends to be a high age group to present with it as well, but no other risk factors are known for the condition.
Bill Klaproth (host): And just to ask, is there any way to prevent this or ward it off, if you will?
Dr. Chike Eseonu: Unfortunately, no. It really comes spontaneously. And then, it's treated, but no, nothing you can do again with lifestyle or certain things you could try to do to prevent it.
Bill Klaproth (host): I'm wondering if this is hard to diagnose. Someone might come in with dull aching teeth or general pain, and you might think it's other things potentially. How important is it to find a provider that really understands something like this who specializes in trigeminal neuralgia?
Dr. Chike Eseonu: Yeah. This is a very important part because it's a very difficult diagnosis to make. You can imagine in this scenario you presented, if you come in and your having some tooth pain, the first thought is, "Let me go see a dentist" or "Let me go see an oral surgeon," which most people do. They may have one or two teeth removed and the pain continues. And they'll go to their family practice physician who has maybe an idea that it may be trigeminal-related. They send them to a neurologist who then, you know, tries to manage the pain. And if not, they can end up with a neurosurgeon. I always say it's very important to try to find a specialist who not only manages the condition routinely, but also provides all the treatment options. And that would mean, you know, whether you're seeing somebody who manages the medications, but then you see a surgeon who does all three, the open surgery, the rhizotomy procedure, or the radiosurgery procedure. It gives you the full gamut of the treatments available to you. And that way you're able to get the best management for your specific condition. So I always say it's very important to have either a provider or be in a system that has the providers that can provide you with all your treatment options.
Bill Klaproth (host): And ultimately then, a neurosurgeon would be the best person qualified to diagnose and treat this?
Dr. Chike Eseonu: Yeah, I see the neurologist as well as the neurosurgeon. Again, with the first-line treatment being medication-based, oftentimes the neurologist is a great place to start. And then, they will get a neurosurgeon involved as needed from that point.
Bill Klaproth (host): And how can a patient find this combination of neurologist and neurosurgeon? What's the best way to do that?
Dr. Chike Eseonu: Normally, it's looking at a lot of the hospital systems. I'm at the University of Pittsburgh Medical Center here in central Pennsylvania where we have a team of neurologist and neurosurgeon to collaborate together so that once you're in the system, once you're being evaluated and diagnosed, you kind of have all of those treatment options available to you. So it's always nice to find an area where one day they had that combination of the neurologists and neurosurgeons or there's also Facial Pain Organization who has a lot of specialty groups and support groups that have trigeminal neuralgia as well as other facial pain issues. And they have a nice directory on their website, just the people who specifically specialize in trigeminal neuralgia.
Bill Klaproth (host): Absolutely. Well, of course, as you mentioned, UPMC Neurosurgery would be a great place to come if you're feeling these symptoms, is that right?
Dr. Chike Eseonu: Yes, absolutely.
Bill Klaproth (host): So as we wrap up, Dr. Eseonu, and thank you so much for your time, this has been great, any final thoughts for someone trying to research or understand or going through trigeminal neuralgia?
Dr. Chike Eseonu: Yeah, you know, trigeminal neuralgia is a very hard condition to either go through or have a family or friend go through. It's often in a patient's best interest to, again, look for providers who offer that full treatment option for them and to not get overdiscouraged because certainly, in this area and in many areas, there are these providers who can provide treatment provider relief. So my big take-home message is that those patients or your family, friends that may be suffering the condition to not give up hope and instead, you know, look to find providers who specialize in that management to see if they can help them.
Bill Klaproth (host): Right. So I think the bottom line is through proper treatment, this can be managed.
Dr. Chike Eseonu: Correct.
Bill Klaproth (host): Well, that is great to hear. Well, Dr. Eseonu, thank you so much for your time. This has really been fascinating. We appreciate it. Thanks again.
Dr. Chike Eseonu: Great. Thank you very much.
Bill Klaproth (host): And once again, that's Dr. Chikezie Eseonu. And for more information, please visit upmc.com/centralpaneuro. That's upmc.com/centralpaneuro. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Healthier You, a podcast from UPMC. I'm Bill Klaproth. Thanks for listening.
Bill Klaproth (host): So are you experiencing painful sensation similar to an electric shock on one side of your face or your forehead or other types of stabbing pains in your face? I'll tell you, this can be scary and painful. It could be trigeminal neuralgia. So let's learn more about that with Dr. Chikezie Eseonu, neurosurgery clinical assistant professor with UPMC Neurological Institute and UPMC Neurosurgery.
This is Healthier You, a podcast from UPMC. I'm Bill Klaproth. Dr. Eseonu, thank you so much for your time. This is really an interesting topic. Looking forward to talking to you about this. So first off, just so we all know, what is trigeminal neuralgia?
Dr. Chike Eseonu: Yeah, thank you for having me. The trigeminal neuralgia is a facial pain syndrome affecting the trigeminal nerve. The trigeminal nerve is a nerve that controls mainly the sensation of your face. and when you have any issue with it in the form of trigeminal neuralgia, it can cause sharp stabbing-like pains normally on one side, sometimes on both sides of your face, that are pretty severe, you know, leaving patients in extreme pain with inability to speak, eat, chew or even smile.
Bill Klaproth (host): Wow. Okay. So the symptoms are pain, inability to eat, speak, or even smile. Are there other symptoms someone should be aware of?
Dr. Chike Eseonu: Yeah. It normally comes in two different types, either a typical trigeminal neuralgia or atypical. The typical one is that sharp stabbing pain. It can be either in your forehead, your cheek, your lower jaw, or kind of a combination of one of those three. And it lasts normally for a minute or two, can self-resolve, but then can constantly come back.
The atypical form tends to be not so much a stabbing pain, but more of a dull burning pain, again, normally on one side of your face that again is a little more constant. Normally, that's the main presenting feature for that syndrome. And then, you can imagine if your teeth hurt, your face also hurts, it can be difficult do a lot of things.
Bill Klaproth (host): I imagine it must be scary too, I'll say, and you're getting this sharp stabbing pain, you know, across your face or your forehead or the dull aching sensation, someone might feel like, "What is going on with me? What is this?" So I bet it's scary as well. Do we know what causes this, Dr. Eseonu?
Dr. Chike Eseonu: Yes. Normally, it's an issue with the trigeminal nerve itself. And this issue can present from something compressing on the nerve, whether it's a tumor, whether it's a blood vessel. Sometimes the issue of multiple sclerosis can cause some deformities in the outer surface or the protective covering of the nerve called myelin. And then, it makes it for a defective nerve. And when you have a defective nerve, instead of doing its normal job of giving you sensation to your face, it starts shooting out abnormal signals that present themselves as the sharp facial pain.
Bill Klaproth (host): Where is the trigeminal nerve located?
Dr. Chike Eseonu: So it's in the kind of middle center part of your brain called the brainstem. Essentially, if you started kind of from your nose and kind of started working your way deep into your head, that's sort of where the brain stem is located. And it generates from there and moves through the facial bone into the surface of your facial skin. And that's kind of the pathway of the trigeminal nerve.
Bill Klaproth (host): So, how do you diagnose this? Is this this with MRI or x-ray or physical examination? How do you diagnose it?
Dr. Chike Eseonu: Yeah. Normally, it's a diagnosis of symptoms. If you're having the type of pain that I had mentioned earlier, that normally can get you a diagnosis of trigeminal neuralgia. And then, you can use imaging studies, like an MRI scan of the brain to evaluate what the nerve itself looks like, whether there is compression on the nerve or whether they're just some visible abnormality of the nerve that may explain the issue.
Bill Klaproth (host): So then, once it is determined that the person is suffering from trigeminal neuralgia, how do you treat this?
Dr. Chike Eseonu: There's multiple methods of treatment. The first-line method is medication-based, and this can be either through your primary care physician, or you may have a specialized neurologist who works with this condition. And the medications tend to be either antiseizure medication. There's some kind of antidepressant medications that also can help with the pain, but tends to be fairly effective in normally 90% of people.
If for whatever reason you're not able to tolerate the medication, it's making it too sleepy or you're just not functioning properly on them, the next line of treatment, comes into my room of neurosurgery where it could be a surgical intervention where either I look to try to decompress the nerve, whether if it's being compressed by a tumor or some vessel. Or there's some simpler procedures that are less invasive, such as one's called a trigeminal rhizotomy, which is an outpatient procedure where you essentially get an injection into the trigeminal nerve to try to control the pain. Or the third line would be radiation treatment where we target radiation to that trigeminal nerve in an attempt to try to cool down or kill off those bad nerves that are causing the pain.
Bill Klaproth (host): So with treatment, what is the longterm prognosis for someone with trigeminal neuralgia? You said medication, I think, is effective 90% of the time. There's also surgical intervention. And then, you said there's less invasive methods. How well do these treatment options work?
Dr. Chike Eseonu: The overall treatment is very effective. But again, usually mainly on the word treatment, meaning, you know, it is a lifelong condition that's managed when it is managed with medications. There are certain situations where if that nerve is compressed by something and you undergo an open surgery to decompress the nerve, that can be more of a curative treatment as long as that decompression remains. But then, the others are again treatments, but can reduce, if not eliminate, your facial pain for long durations of time and allow you to live a normal life while you're being managed for the condition.
Bill Klaproth (host): So it sounds like this doesn't go away on its own.
Dr. Chike Eseonu: Correct. You may have intervals of no pain, which can last hours, can last days, can even last up to years, but it will recurrently come back from time to time over time without any specific treatment.
Bill Klaproth (host): Yeah. Are there certain risk factors involved in this?
Dr. Chike Eseonu: No specific risk factors as far as genetics go or any indications of lifestyle that may predispose you to trigeminal neuralgia. Overall, women tend to be more likely to have trigeminal neuralgia than man and with a 2:1 ratio. Also, age, you know, around the age of 50 tends to be a high age group to present with it as well, but no other risk factors are known for the condition.
Bill Klaproth (host): And just to ask, is there any way to prevent this or ward it off, if you will?
Dr. Chike Eseonu: Unfortunately, no. It really comes spontaneously. And then, it's treated, but no, nothing you can do again with lifestyle or certain things you could try to do to prevent it.
Bill Klaproth (host): I'm wondering if this is hard to diagnose. Someone might come in with dull aching teeth or general pain, and you might think it's other things potentially. How important is it to find a provider that really understands something like this who specializes in trigeminal neuralgia?
Dr. Chike Eseonu: Yeah. This is a very important part because it's a very difficult diagnosis to make. You can imagine in this scenario you presented, if you come in and your having some tooth pain, the first thought is, "Let me go see a dentist" or "Let me go see an oral surgeon," which most people do. They may have one or two teeth removed and the pain continues. And they'll go to their family practice physician who has maybe an idea that it may be trigeminal-related. They send them to a neurologist who then, you know, tries to manage the pain. And if not, they can end up with a neurosurgeon. I always say it's very important to try to find a specialist who not only manages the condition routinely, but also provides all the treatment options. And that would mean, you know, whether you're seeing somebody who manages the medications, but then you see a surgeon who does all three, the open surgery, the rhizotomy procedure, or the radiosurgery procedure. It gives you the full gamut of the treatments available to you. And that way you're able to get the best management for your specific condition. So I always say it's very important to have either a provider or be in a system that has the providers that can provide you with all your treatment options.
Bill Klaproth (host): And ultimately then, a neurosurgeon would be the best person qualified to diagnose and treat this?
Dr. Chike Eseonu: Yeah, I see the neurologist as well as the neurosurgeon. Again, with the first-line treatment being medication-based, oftentimes the neurologist is a great place to start. And then, they will get a neurosurgeon involved as needed from that point.
Bill Klaproth (host): And how can a patient find this combination of neurologist and neurosurgeon? What's the best way to do that?
Dr. Chike Eseonu: Normally, it's looking at a lot of the hospital systems. I'm at the University of Pittsburgh Medical Center here in central Pennsylvania where we have a team of neurologist and neurosurgeon to collaborate together so that once you're in the system, once you're being evaluated and diagnosed, you kind of have all of those treatment options available to you. So it's always nice to find an area where one day they had that combination of the neurologists and neurosurgeons or there's also Facial Pain Organization who has a lot of specialty groups and support groups that have trigeminal neuralgia as well as other facial pain issues. And they have a nice directory on their website, just the people who specifically specialize in trigeminal neuralgia.
Bill Klaproth (host): Absolutely. Well, of course, as you mentioned, UPMC Neurosurgery would be a great place to come if you're feeling these symptoms, is that right?
Dr. Chike Eseonu: Yes, absolutely.
Bill Klaproth (host): So as we wrap up, Dr. Eseonu, and thank you so much for your time, this has been great, any final thoughts for someone trying to research or understand or going through trigeminal neuralgia?
Dr. Chike Eseonu: Yeah, you know, trigeminal neuralgia is a very hard condition to either go through or have a family or friend go through. It's often in a patient's best interest to, again, look for providers who offer that full treatment option for them and to not get overdiscouraged because certainly, in this area and in many areas, there are these providers who can provide treatment provider relief. So my big take-home message is that those patients or your family, friends that may be suffering the condition to not give up hope and instead, you know, look to find providers who specialize in that management to see if they can help them.
Bill Klaproth (host): Right. So I think the bottom line is through proper treatment, this can be managed.
Dr. Chike Eseonu: Correct.
Bill Klaproth (host): Well, that is great to hear. Well, Dr. Eseonu, thank you so much for your time. This has really been fascinating. We appreciate it. Thanks again.
Dr. Chike Eseonu: Great. Thank you very much.
Bill Klaproth (host): And once again, that's Dr. Chikezie Eseonu. And for more information, please visit upmc.com/centralpaneuro. That's upmc.com/centralpaneuro. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Healthier You, a podcast from UPMC. I'm Bill Klaproth. Thanks for listening.