Trigeminal Neuralgia

When medication no longer provides adequate relief, Dr. Almeida’s practice focuses on minimally invasive percutaneous procedures and stereotactic radiosurgery. Microvascular decompression may be appropriate for selected patients; when it is the better option, evaluation by an MVD specialist can be discussed.

Sudden, severe facial pain

Brief "electric shock" episodes, often triggered by light touch, chewing, talking, or brushing teeth.

Medication is first-line

Carbamazepine or oxcarbazepine often help, but some patients become refractory or can't tolerate side effects.

Procedural options available

Percutaneous procedures and stereotactic radiosurgery are available options; microvascular decompression may be appropriate for selected patients through referral.

Understanding your condition

What is trigeminal neuralgia?

Trigeminal neuralgia (TN) is a condition that causes intense, sudden episodes of facial pain, often described as an electric shock. It's typically related to irritation of the trigeminal nerve, which carries sensation from the face to the brain.

Pain episodes can be disabling, but many patients respond well to a structured treatment pathway that begins with medication and progresses to procedural care when needed. The goal is always to find the approach that best balances pain relief with your tolerance for side effects.

Am I a candidate?

Who may benefit from a procedure?

You may be a candidate if:

Most patients start with medication: procedures are considered when that's no longer sufficient.

Your symptoms fit the pattern of trigeminal neuralgia and you have tried appropriate medications, or cannot tolerate their side effects.
Your pain significantly impairs quality of life and you're looking for an option beyond medications.

Your options

Treatment Options

Each approach targets the trigeminal nerve differently. The choice depends on the diagnosis, MRI findings, overall health, prior treatment, and your priorities for durability, recovery, and sensory effects.

Percutaneous

Radiofrequency Ablation

Percutaneous thermocoagulation of the trigeminal ganglion

How it works A needle is guided to the trigeminal ganglion, and controlled heat creates a small lesion to reduce pain transmission.

Recovery Short procedure, often same-day discharge. Many return to light activities within days.

Trade-off Often offers rapid relief, but facial numbness is common and expected.

Rapid relief Minimally invasive Same-day

Percutaneous

Balloon Compression

Mechanical compression of the trigeminal ganglion

How it works A small balloon is placed at the trigeminal ganglion and briefly inflated to compress the pain-transmitting fibers.

Recovery Often performed under general anesthesia. Designed for fast recovery with same-day or next-day discharge.

Trade-off Effective and fast, but facial numbness and temporary jaw (masseter) weakness can occur.

Fast recovery Under anesthesia Same-day

Radiosurgery

Stereotactic Radiosurgery

Focused radiation targeting the trigeminal nerve

How it works Precisely focused radiation beams target a segment of the trigeminal nerve, no incision or needle passed to the nerve. A head frame may require pins and local anesthetic injections.

Recovery Outpatient. Pain relief is typically slower and more gradual, developing over weeks.

Trade-off No open operation; relief develops gradually. Facial numbness and delayed radiation effects remain possible.

No incision No nerve puncture Lower numbness risk

Microsurgery

Microvascular Decompression: Specialist Evaluation

Open microsurgery that separates an offending blood vessel from the trigeminal nerve. Dr. Almeida does not perform MVD; patients for whom it may be the preferred option can be evaluated by an MVD specialist.

How it worksThrough an opening behind the ear, the surgeon separates a compressing blood vessel from the nerve. It aims to relieve compression without intentionally injuring the nerve.

Who may benefitSelected patients with classical trigeminal neuralgia and a suitable pattern of vascular compression who can undergo open surgery.

Trade-offPain relief can be rapid and durable, but treatment requires general anesthesia and hospital recovery. Risks include hearing loss, spinal-fluid leak, bleeding, infection, stroke, and recurrent pain.

Comparing less invasive procedures

Balancing speed of relief, invasiveness, and numbness risk.

Swipe to compare →

Feature	Radiofrequency	Balloon	Radiosurgery
Approach	Needle + heat	Needle + balloon	Focused radiation
Incision / needles	Needle (percutaneous)	Needle (percutaneous)	No nerve puncture; frame pins may be used
Anesthesia	Sedation (brief awake)	General anesthesia	Local anesthetic for a frame; sedation varies
Speed of relief	Often immediate	Often immediate	Gradual (weeks)
Numbness risk	Common / expected	Common / expected	Generally lower
Typical stay	Same day	Same day	Same day (outpatient)
Repeatable	Yes	Yes	Sometimes (with caution)

Your journey

What to Expect

All options begin with a thorough evaluation to confirm your diagnosis and match the right procedure to your goals.

Before your procedure

MRI review (often to assess neurovascular contact), medication review, and a discussion of your goals, including how you weigh fast relief versus an incisionless approach versus long-term durability.

During

Radiofrequency or balloon compression: Short procedural time, often same-day discharge.
Radiosurgery: Outpatient treatment with head immobilization; a frame may use pins and local anesthetic injections.
MVD: Open surgery under general anesthesia, followed by hospital recovery.

After

You'll track pain triggers and medication needs over the following weeks. Some patients are able to taper medications as pain control improves, guided by the clinical team. Follow-up visits focus on pain control, sensory exam, and your medication plan.

Weighing your decision

Benefits and Risks

Potential Benefits

Meaningful pain reduction, often dramatic improvement
Percutaneous procedures often act quickly
Radiosurgery avoids an open operation and nerve puncture
Potential to reduce or stop daily medications

Possible Risks

Common: Facial numbness, transient jaw weakness, reduced corneal reflex
Uncommon: Anesthesia dolorosa (painful numbness), corneal injury or keratitis, infection/bleeding, or delayed radiation injury (radiosurgery)

A note about corneal sensation

Some procedures can reduce corneal reflex (the protective blink response). If this occurs, eye protection strategies become important. Your team will discuss this before any procedure and monitor it during follow-up.

Common questions

Patient FAQs

Will my face be numb after treatment?

Some degree of numbness is common with percutaneous procedures and can also occur after radiosurgery. Your team will counsel you on the expected trade-offs between pain relief and sensory changes before any procedure.

How fast does radiosurgery work?

Often gradually over weeks. Immediate relief is less common with radiosurgery compared to percutaneous approaches. The trade-off is a generally lower risk of facial numbness.

Can trigeminal neuralgia come back?

Yes: recurrence can occur with all procedures. If pain returns, a repeat treatment or a different technique may be considered depending on your history and response to the initial procedure.

When to Seek Emergency Care

Call 911 in the United States, or your local emergency number elsewhere, now for sudden weakness or numbness on one side; new trouble speaking, seeing, walking, or staying awake; loss of consciousness; trouble breathing; a first seizure; a seizure lasting 5 minutes or longer; repeated seizures without recovery; a seizure with serious injury or in water; or a sudden, severe headache. If you have epilepsy, follow your seizure action plan when it applies.

Contact your care team today for fever, wound redness or drainage, medication side effects, worsening pain, new balance or sensory symptoms, or other concerns that are not immediately life-threatening.

Last updated September 2026.