Trigeminal Neuralgia: the facial nerve “short circuit” that causes one of the most intense pains known

The trigeminal nerve—responsible for collecting facial sensations such as pain, temperature, and touch, and essential for functions like chewing—can become the source of one of the most disabling pains when its function is altered. This condition is known as trigeminal neuralgia, a disorder that, although not widely known, affects thousands of people in Spain.

"The trigeminal nerve is like a cable that gathers all the sensation from the face. When that ‘cable’ is damaged—usually because a blood vessel compresses it—it starts sending brutal pain signals," explains Dr. Juan Carlos Gómez Angulo, neurosurgeon in the team of José Manuel del Pozo at Hospital Ruber Internacional.

Sudden and disabling pain

High resolution image. This link will open using lightbox, there may be a context switchDr. Gomez AnguloTrigeminal neuralgia is characterized by episodes of intense pain, described by patients as electric shocks. These attacks can be triggered by everyday actions such as talking, chewing, or even by simple skin contact or wind on the face.

"The problem lies in the myelin, the layer that protects the nerve. When that ‘insulation’ is lost, the nerve enters a kind of short circuit, so normal stimuli trigger disproportionate pain," the specialist explains.

Symptoms have very specific features: sudden, short-lasting pain in repeated attacks; very precise localization on one side of the face; and clear triggers, such as brushing teeth or touching the skin.

A clinical diagnosis that requires experience

Although the pain is very characteristic, diagnosis is not based on laboratory tests. "The diagnosis is mainly clinical—that is, it depends on what the patient tells us. There is no test that confirms it," says Dr. Gómez Angulo.

Imaging tests, such as MRI, play a complementary role: ruling out other causes and, in some cases, identifying the blood vessel compressing the nerve.

Although it is not a degenerative disease itself, its progression can severely affect quality of life if not properly treated.

"It does not destroy the nerve, but it usually worsens over time. Attacks become more frequent, longer, and medications lose effectiveness. That’s why it’s important not to resign yourself and to look for solutions," warns the neurosurgeon.

Treatment: from medication to surgery

Initial treatment is pharmacological, aimed at controlling the nerve’s hyperactivity. However, it has limitations.

According to Dr. Gómez Angulo, medications work well at first, but over time they may lose effectiveness and cause significant side effects such as drowsiness or difficulty concentrating. "Some patients feel mentally ‘switched off’," he notes.

When medical treatment becomes ineffective or intolerable, the case is considered resistant and other options are evaluated.

Alternatives for complex cases

In such cases, different therapeutic options are available, from open surgery to minimally invasive procedures.

"Microvascular decompression is the most definitive option because it addresses the root cause by separating the vessel from the nerve. But there are also less invasive techniques, such as percutaneous procedures or stereotactic radiosurgery with Gamma Knife," he explains.

Among these less invasive options, balloon compression stands out. It is performed through a percutaneous approach: "It involves inserting a small balloon that compresses the nerve to interrupt pain signals. It is done under sedation and without opening the skull," he adds.

Another option is stereotactic radiosurgery with Gamma Knife, useful for patients who, due to medical conditions or advanced age, cannot or prefer not to undergo surgery. It does not require hospital admission and is well tolerated, although its effect is not immediate and results usually appear weeks after treatment.

The choice of treatment depends on multiple factors, such as age, overall health, and patient preferences. "There is no single solution for everyone. It is a personalized decision we make together with the patient, explaining the pros and cons. The important thing is that the patient always has the final say," emphasizes Dr. Gómez Angulo.

In this regard, "it is essential to go to centers with multidisciplinary teams and experience in the different therapeutic alternatives available, as this allows for a more comprehensive and tailored approach to each case," the neurosurgeon concludes.