What is the trigeminal nerve and what causes trigeminal neuralgia?
The trigeminal nerve (also called the fifth cranial nerve) is one of the main nerves of the face. There is one on each side. It comes through the skull from the brain, in front of the ear. The trigeminal nerve splits into three main branches. Each branch divides into many smaller nerves:
- The nerves from the first (ophthalmic) branch go to your scalp, forehead and around your eye.
- The nerves from the second (maxillary) branch go to the area around your cheek.
- The nerves from the third (mandibular) branch go to the area around your jaw.
The branches of the trigeminal nerve take sensations of touch and pain to the brain from your face, teeth and mouth. The trigeminal nerve also controls the muscles used in chewing and in the production of saliva and tears.
Usually one or both of the maxillary and mandibular branches are affected by trigeminal neuralgia. It is uncommon for only the ophthalmic branch to be affected. Only about 3 in 100 cases of trigeminal neuralgia affect both sides (are bilateral). It is much more common for people with bilateral trigeminal neuralgia to have other people in their family affected by the condition.
In about 80-90 out of 100 cases of trigeminal neuralgia it is thought that the cause is pressure on the nerve (compression) by a loop of artery or vein. Much more rarely, trigeminal neuralgia is a symptom of another condition, like a tumour, multiple sclerosis, or an abnormality of the base of the skull. In some cases, the cause is not known.
Further reading and references
Trigeminal neuralgia; NICE CKS, December 2014 (UK access only)
Deep brain stimulation for intractable trigeminal autonomic cephalalgias; NICE Interventional Procedure Guideline, March 2011
Montano N, Conforti G, Di Bonaventura R, et al; Advances in diagnosis and treatment of trigeminal neuralgia. Ther Clin Risk Manag. 2015 Feb 2411:289-99. doi: 10.2147/TCRM.S37592. eCollection 2015.
Zakrzewska JM, Linskey ME; Trigeminal neuralgia. BMJ. 2014 Feb 17348:g474. doi: 10.1136/bmj.g474.
Zhang J, Yang M, Zhou M, et al; Non-antiepileptic drugs for trigeminal neuralgia. Cochrane Database Syst Rev. 2013 Dec 312:CD004029. doi: 10.1002/14651858.CD004029.pub4.
Parmar M, Sharma N, Modgill V, et al; Comparative Evaluation of Surgical Procedures for Trigeminal Neuralgia. J Maxillofac Oral Surg. 2013 Dec12(4):400-409. Epub 2012 Nov 29.
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