Hypertension appears to increase the risk of trigeminal neuralgia, according to a new study published in Neurology by Taiwanese researchers. They looked at 138,492 people with hypertension and compared them to 276,984 people of similar age and sex who did not have hypertension. The risk of trigeminal neuralgia was one and half times higher in those with high blood pressure. Trigeminal neuralgia is an extremely painful condition with electric-like pain in one or more branches of the trigeminal nerve, which supplies sensation to the face. The likely cause of trigeminal neuralgia is compression of the trigeminal nerve by a blood vessel at the site where the nerve is coming out of the brainstem. Persistently elevated blood pressure tends to make blood vessels harder and more tortuous. Hypertension has been show to be a factor in a similar condition – hemifacial spasm, which results from the compression of the facial nerve by a blood vessel. The usual treatment of trigeminal neuralgia starts with medications, such as oxcarbazepine (Trileptal), carbamazepine (Tegretol), phenytoin (Dilantin), baclofen (Lioresal) and other. If medications are ineffective, invasive treatments are recommended. Botox injections have been reported to provide some patients with good relief, although Botox is probably more effective for hemifacial spasm. ANother procedure is the destruction of the tigeminal nerve ganglion with heat from a radiofrequency probe. This is done under X-ray guidance. Radiofrequency ablation is often effective, but the pain may recur and the procedure may need to be repeated. A more drastic but also more effective approach involves opening the skull and placing a Teflon patch between the nerve and the offending blood vessel. Obviously, this procedure carries a higher risk of serious complications, but in experienced hands it is relatively safe. You can determine the experience of the neurosurgeon by asking how many procedure he or she has performed. Ideally, pick a surgeon who has done it hundreds of times.
