We offer a variety of therapeutic and surgical options for facial pain based on individual patient needs.
The type of medications we prescribe depend on the cause of face pain, as different medical treatment options can be effective. Since some of these medications may have side effects during the course of treatment, regular follow-up and blood work may be necessary.
For classic trigeminal neuralgia, Carbamazepine and its family (e.g. Oxcarbazepine) is the gold standard treatment.
Some patients with facial pain benefit from holistic therapeutic options, such as massage or acupuncture. We strive to balance our treatments so that patients have access to different facets of medical care, including holistic treatment.
Procedural treatments for face pain range from injections, such as peripheral nerve blocks, occipital nerve blocks, and sphenopalatine ganglion blocks, to Botox therapy. These procedures can both be used as treatment options, and occasionally as diagnostic tools to help understand the precise origin of pain.
Neurosurgical management of facial pain is complex and the technique we use depends on the source of the pain. Options include:
Microvascular decompression (MVD) of the trigeminal nerve is the treatment of choice for patients with classic symptoms of trigeminal neuralgia whose MRI reveals a compressive vessel and who are fit to undergo surgery.
This procedure involves making a small, linear incision behind the ear, and making a quarter-sized opening in the skull to access the region of compression with a microscope. The offending vessel is dissected away from the nerve and moved aside. The vessel and the nerve are traditionally kept away from each other in the long term by the placement of a piece of Teflon, a substance that acts as a pillowy buffer.
At UC San Diego Health, we have pioneered a novel approach to displacing the vessel, which we use in certain circumstances. This involves the creation of a sling in which the artery is tacked up away from the nerve without the need for foreign material.
Gamma Knife Radiosurgery
For those patients who are not candidates for microvascular decompression, gamma knife radiosurgery offers a less invasive option. This procedure is not a surgery and does not involve a skin incision or anesthesia. In this procedure, a special head frame is placed and an MRI is obtained to precisely locate the nerve.
The physicians hold a planning session to design the treatment, in which many beams of radiation are focused through the skin and precisely targeted onto the trigeminal nerve. The procedure does not cause pain, and the treatment takes several weeks to several months to take full effect.
In some cases, your neurosurgeon may offer percutaneous procedures, in which a needle is placed through the cheek and under fluoroscopic guidance, inserted into the foramen ovale, where branches of the trigeminal nerve can be found. Different therapeutic options using this technique are possible, including the injection of a numbing medication called Glycerol, radiofrequency ablation (RF ablation), or balloon compression of the nerve.
Peripheral Nerve and Peripheral Nerve Field Stimulation (PNS and PNFS)
In certain circumstances, small, thin wire electrodes can be placed underneath the skin in areas of the face in which pain is felt, which can alleviate the pain. This is first performed as a trial, where its efficacy is tested for several days. If the stimulation is felt to relieve at least 50% or more of the pain, it is subsequently implanted as a permanent stimulator.
Nucleus Caudalis Dorsal Root Entry Zone Lesioning (DREZ)
In certain circumstances, a different part of the pain pathway must be targeted to relieve pain. In this procedure, a specialized probe is used to target the nucleus caudalis, a nucleus in the brainstem that controls pain processing in the facial region.